ArticleThe Journal of asthma : official journal of the Association for the Care of Asthma2015
Clinical pathway improves pediatrics asthma management in the emergency department and reduces admissions.
Article in The Journal of asthma : official journal of the Association for the Care of Asthma, 2015. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
What it found
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The trial behind it
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Who cites it
24 citing papers in PubMed.
- Fractured Neck of Femur Clinical Pathway Use in Tasmanian Emergency Departments: A Retrospective Study.Emergency medicine Australasia : EMA · 2025Article
- The Use of Clinical Pathways in Emergency Departments: A Scoping Review.Health services insights · 2025Review
- Managing Pediatric Asthma Exacerbations: The Role of Timely Systemic Corticosteroid Administration in Emergency Care Settings-A Multicentric Retrospective Study.Children (Basel, Switzerland) · 2024Article
- Evaluating the Clinical Impact of a Novel Pediatric Emergency Medicine Curriculum on Asthma Outcomes in Belize.Pediatric emergency care · 2022Article
- Variation in Pediatric Asthmonia Diagnosis and Outcomes among Hospitalized Children.Annals of the American Thoracic Society · 2021Article
- Article
- Paediatrics: how to manage acute asthma exacerbations.Drugs in context · 2021Review
- Emergency department treatment of asthma in children: A review.Journal of the American College of Emergency Physicians open · 2020Review
- Pediatric asthma pathway in the emergency room.Proceedings (Baylor University. Medical Center) · 2020Article
- Current practices in children with severe acute asthma across European PICUs: an ESPNIC survey.European journal of pediatrics · 2020Article
- Michigan Emergency Department Leader Attitudes Toward and Experiences With Clinical Pathways to Guide Admission Decisions: A Mixed-methods Study.Academic emergency medicine : official journal of the Society for Academic Emergency Medicine · 2019Article
- Reducing Hospitalization Rates for Children With Anaphylaxis.Pediatrics · 2017Article
- Acute Asthma in the Pediatric Emergency Department: Infections Are the Main Triggers of Exacerbations.BioMed research international · 2017Article
- Asthma-related emergency department use: current perspectives.Open access emergency medicine : OAEM · 2016Review
- A Quality Improvement Initiative to Improve the Administration of Systemic Corticosteroids in the Pediatric Emergency Department.Pediatric quality & safetyArticle
- A Report of an Asthma Pathway Leading to Improved Resource Use.The journal of pediatric pharmacology and therapeutics : JPPT : the official journal of PPAGArticle
- Decreasing ICU and Hospital Length of Stay through a Standardized Respiratory Therapist-driven Electronic Clinical Care Pathway for Status Asthmaticus.Pediatric quality & safetyArticle
- Describing the evidence linking interprofessional education interventions to improving the delivery of safe and effective patient care: a scoping review.Journal of interprofessional careArticle
- A Quality Improvement Initiative to Minimize Unnecessary Chest X-Ray Utilization in Pediatric Asthma Exacerbations.Pediatric quality & safetyArticle
- Improving Care for Children with Bloody Diarrhea at Risk for Hemolytic Uremic Syndrome.Pediatric quality & safetyArticle
Corrections and comments
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Authors and funding
3 authors.
Funding
Abstract
objectivePoor adherence to the National Institute of Health (NIH) Asthma Guidelines may result in unnecessary admissions for children presenting to the emergency department (ED) with exacerbations. We determine the effect of implementing an evidence-based ED clinical pathway on corticosteroid and bronchodilator administration and imaging utilization, and the subsequent effect on hospital admissions in a US ED.
methodsA prospective, interventional study of pediatric (≤21 years) visits to an academic ED between 2011 and 2013 with moderate-severe asthma exacerbations has been conducted. A multidisciplinary team designed a one-page clinical pathway based on the NIH Guidelines. Nurses, respiratory therapists and physicians attended educational sessions prior to the pathway implementation. By adjusting for demographics, acuity and ED volume, we compared timing and appropriateness of corticosteroid and bronchodilator administration, and chest radiograph (CXR) utilization with historical controls from 2006 to 2011. Subsequent hospital admission rates were also compared.
resultsA total of 379 post-intervention visits were compared with 870 controls. Corticosteroids were more likely to be administered during post-intervention visits (96% vs. 78%, adjusted OR 6.35; 95% CI 3.17-12.73). Post-intervention, median time to corticosteroid administration was 45 min faster (RR 0.74; 95% CI 0.67-0.81) and more patients received corticosteroids within 1 h of arrival (45% vs. 18%, OR 3.5; 95% CI 2.50-4.90). More patients received > 1 bronchodilator dose within 1 h (36% vs. 24%, OR 1.65; 95% CI 1.23-2.21) and fewer received CXRs (27% vs. 42%, OR 0.7; 95% CI 0.52-0.94). There were fewer admissions post-intervention (13% vs. 21%, OR 0.53; 95% CI 0.37-0.76).
conclusionA clinical pathway is associated with improved adherence to NIH Guidelines and, subsequently, fewer hospital admissions for pediatric ED patients with asthma exacerbations.
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