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Current Practice in the Context of the National Institutes of Health Guidelines

Ellen F. Crain, MD, PhD; Kevin B. Weiss, MD; Michael J. Fagan, MPP

Arch Pediatr Adolesc Med. 1995;149(8):893-901.

Abstract
Objectives
To determine whether US emergency department care for pediatric asthma conforms to the National Institutes of Health guidelines and whether the guidelines are likely to be adopted in clinical practice.

Design
Mail survey conducted from January to April 1992, and stratified by hospital type (children's, public, and community).

Settings
Emergency departments of US hospitals.

Participants
Simple stratified random sample of emergency department directors from 376 sampled hospitals.

Measurements
Self-reported data on emergency department pediatric asthma care, and knowledge and attitudes about the National Institutes of Health guidelines. Data are reported as mean (±SE).

Results
Sixty-eight percent of the surveyed emergency department directors responded. During 1991, there were an estimated 1.6 million visits for pediatric asthma care. Asthma accounted for 16.9% (±9.0%) of all pediatric emergency department visits. Only 2.1% (±1.0%) reported the use of written protocols or guidelines, with significant variation by hospital type. Sixty-seven percent (±3.0%) reported the use of pulse oximetry. Eighty percent reported the use of β-agonists by inhalation as the initial treatment. Only 44.7% (±2.9%) reported the use of steroids if there was a poor response to the initial treatment. An estimated 45.5% (±3.9%) of respondents had heard of the guidelines at the time of this survey; approximately 24% reported that they had read the guidelines. Most respondents reported that the guidelines were credible, clear and concise, and likely to be adopted in their emergency department.

Conclusions
These data suggest that reported pediatric asthma care in US emergency departments differs substantially from the National Institutes of Health guidelines, with considerable variation by hospital type. The guidelines appear to provide an acceptable tool for emergency departments to use in assessing their pediatric asthma care. However, in light of the lack of evidence that the guidelines will improve outcomes, the impact of national guideline adoption remains unclear.

(Arch Pediatr Adolesc Med. 1995;149:893-901)

Author Affiliations
From the Department of Pediatrics, Albert Einstein College of Medicine and Division of General Pediatrics (Emergency Medicine), Bronx (NY) Municipal Hospital Center (Dr Crain); the Center for Health Services Research, Rush Primary Care Institute, Rush Medical College, Chicago, Ill (Dr Weiss); and the Center for Health Policy Research, George Washington University, Washington, DC (Mr Fagan).

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