Pediatrics |

Effectiveness of Ramathibodi's Pediatric Acute Asthma Management (R-PAAM) Guidelines in Emergency Department FREE TO VIEW

Koonkoaw Roekworachai, MD; Uthen Pandee, MD; Harutai Kamalaporn, MD; Wiparat Manuyakorn, MD
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Ramathibodi, Chiamgmai, Thailand

Chest. 2015;148(4_MeetingAbstracts):783A. doi:10.1378/chest.2260925
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SESSION TITLE: Pediatrics Posters

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Asthma exacerbations in children remains common problems in emergency departments (ED). We developed Ramathibodi's Pediatric Acute Asthma Management (R-PAAM) guidelines which were available since 2013. This study is aimed for evaluation of guidelines' effectiveness in ED at Ramathibodi hospital. Our hypothesis is appropriate management of pediatric asthma in ED may prevent hospitalization and urge ED patients' flow.

METHODS: Medical records of all pediatric patients with acute asthmatic attack who visited ED at Ramathibodi hospital since April 2013 to April 2014 were retrospectively reviewed. Asthma Management in ED was mainly provided by pediatric residents who freely decided whether to use R-PAAM guidelines. Clinical severity of asthma was determined by asthma's scores including respiratory rate, oxygen saturation, wheezing, and chest wall retraction. The patients were categorized into 2 groups; Guidelines use and non-guidelines use. Comparisons were made between 2 groups in terms of admission rate, systemic corticosteroids used, time spent in ED and revisited rate to ED.

RESULTS: During study period, 94 ED visits were recruited. 63.8% were male. Median age was 5 (range 3-8) year. 57.4% of patients had mild exacerbations (clinical scores 1-3). R-PAAM guidelines were used in 39 visits (41.5%). Comparison between guideline-used and non-used group, we found that there were no statistical difference in age (5 vs 4 yr, p=0.57), previously diagnosed asthma (87.1% vs 89.1%, p=1.00), history of PICU admission (10.2% vs 7.2%, p=0.71) and severity score at ED presentation (3.67 vs 3.06, p=0.09). Admission rate (25.6% vs 32.7%, p=0.46), systemic corticosteroids used (38.5% vs 36.4%, p=0.84), time spent in ED (90 vs 76 min, p=0.35), and revisited rate (2.6% vs 7.3%, p=0.40) were also not significantly different among two groups. Subgroup analysis in mild exacerbation patients revealed that the patients in guideline-used group had lower admission rate compared to ones in non-used group (0% vs 20%, p=0.04).

CONCLUSIONS: According to our current data, R-PAAM Guidelines showed a promising trend as a hospitalized- reduction tool for pediatric patients who had mild exacerbation. Further study is needed with larger sample size to find the definite conclusion.

CLINICAL IMPLICATIONS: R-PAAM guidelines use for clinical assessment and appropriate management in ED may reduce unnecessary admission for children with acute asthmatic attack.

DISCLOSURE: The following authors have nothing to disclose: Koonkoaw Roekworachai, Uthen Pandee, Harutai Kamalaporn, Wiparat Manuyakorn

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