This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (20)  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Topic Collections  • Asthma  • Immunology  • Allergy  • Alert me on articles by topic  Social Bookmarking   What's this?

Karen M. McDowell, MD; Robert L. Chatburn, RRT; Timothy R. Myers, RRT; Mary Ann O'Riordan, MS; Carolyn M. Kercsmar, MD

Arch Pediatr Adolesc Med. 1998;152:977-984.

Objective  To test the ability of an assessment-driven algorithm for treatment of pediatric status asthmaticus to reduce length and cost of hospitalization.

Design  Nonrandomized, prospective, controlled trial.

Setting  Tertiary care children's hospital.

Patients  Children aged 1 to 18 years hospitalized for status asthmaticus; 104 were treated using the asthma care algorithm (intervention) and 97 using unstructured standard treatment (control).

Intervention  Patients were treated using either an assessment-based algorithm or standard care practices. The algorithm group was treated with standard medications (aerosolized albuterol, systemic corticosteroids, epinephrine, ipratropium) administered at a frequency driven by the patient's clinical condition. Specific criteria were outlined for decreasing or augmenting therapy, transferring to intensive care, and discharging to home. A unique patient record containing assessments, algorithm cues, and a treatment record was used. Intervention group patients were interviewed by telephone 1 week after discharge.

Main Outcome Measures  Hospital length of stay, cost per hospitalization, relapse rate, protocol adherence.

Results  Average hospital stay for intervention patients was significantly shorter than for control patients (2.0 vs 2.9 days, P<.001). Although intervention patients received fewer aerosolized albuterol doses than controls, there was no difference in short-term relapse rate between groups. The intervention saved more than $700 per patient in hospital charges. Adherence to the protocol was excellent, with only 8 variances per patient stay out of more than 150 opportunities.

Conclusion  An intensive, assessment-driven algorithm for pediatric status asthmaticus significantly reduces hospital length of stay and costs without increasing morbidity.

From the Departments of Pediatrics (Dr Kercsmar and Ms O'Riordan), and Respiratory Therapy (Messers Chatburn and Myers), University Hospitals of Cleveland, Rainbow Babies and Childrens Hospital, Case Western Reserve University, Cleveland, Ohio; and Children's Hospital of Buffalo, Lung Center, Buffalo, NY (Dr McDowell).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Effect of a clinical pathway on the hospitalisation rates of children with asthma: a prospective study
Norton et al.
Arch. Dis. Child. 2007;92:60-66.
ABSTRACT | FULL TEXT  

Asthma Intervention Program Prevents Readmissions in High Healthcare Users
Castro et al.
Am. J. Respir. Crit. Care Med. 2003;168:1095-1099.
ABSTRACT | FULL TEXT  

Acute Severe Asthma
McFadden
Am. J. Respir. Crit. Care Med. 2003;168:740-759.
ABSTRACT | FULL TEXT  

Characteristics of Asthma Care Provided by Hospitals in a Large Metropolitan Area: Results From the Chicago Asthma Surveillance Initiative
Grant et al.
Chest 1999;116 :162S-167S.
ABSTRACT | FULL TEXT  

Algorithm for Children Hospitalized with Asthma
JWatch General 1998;1998:3-3.
FULL TEXT