与普通急诊相比，儿科急诊更可能采用全身皮质激素治疗哮喘恶化
2011/03/24
摘要
目的：研究美国哮喘患儿，哮喘急性发作急诊治疗时是否使用全身皮质激素治疗不足（采用当前NIH治疗指南）及与使用全身皮质激素治疗相关的因素。
方法：本研究采用来自2001～2007年全国医院门诊医疗服务调查的数据。研究对象为年龄≤18岁、急症就诊、初始诊断为哮喘(ICD-9-CM编号 493.xx)、接受支气管扩张剂治疗的患者。主要转归为急诊采用全身皮质激素治疗。独立变量包括：患者因素（如：人口统计学指标、保险、发热、入院）、医生因素（如：服务者类型、辅助用药和推荐检测）及系统因素（如：急诊类型、地理位置、就诊时间、季节、年份）。采用多变量回归分析与全身皮质激素治疗相关的因素。
结果：因急性哮喘急诊就诊的儿童患者中，仅63%的患者使用全身激素治疗。整个研究期内，有全身皮质激素使用增加的趋势（p =0.05）。对潜在的混杂因素进行控制后，与普通急诊相比，儿科急诊更可能采用全身皮质激素治疗（OR = 2.45; 95% CI: 1.26-4.77）。
结论：因哮喘恶化而急诊就诊的儿童患者，全身皮质激素治疗使用不足。与普通急诊相比，儿科急诊更可能采用全身皮质激素来治疗哮喘恶化。因此，与普通急诊相比，儿科急诊医生更可能很好地依从哮喘治疗相关的NIH指南。
（苏楠 审校）
J Asthma. 2010 Nov 30. [Epub ahead of print]
Pediatric Emergency Departments are More Likely Than General Emergency Departments to Treat Asthma Exacerbation With Systemic Corticosteroids.
Bekmezian A, Hersh AL, Maselli JH, Cabana MD.
Department of Pediatrics, University of California, San Francisco.
Abstract
Objective. To determine whether systemic corticosteroids are under-prescribed (as measured by current NIH treatment guidelines) for children in the United States seen in the emergency department (ED) for acute asthma, and to identify factors associated with prescribing systemic corticosteroids.
Methods. We used data from the 2001-2007 National Hospital Ambulatory Medical Care Survey. The study population was children ≤18 years old in the ED with a primary diagnosis of asthma (ICD-9-CM code 493.xx) who received bronchodilator(s). The primary outcome was receipt of a systemic corticosteroid in the ED. Independent variables included patient-level (e.g., demographics, insurance, fever, admission), physician-level (provider type, ancillary medications and tests ordered), and system-level factors (e.g., ED type, geographic location, time of day, season, year). We used multivariable logistic regression techniques to identify factors associated with systemic corticosteroid treatment.
Results. Systemic corticosteroids were prescribed at only 63% of pediatric acute asthma visits to EDs. Over the study period, there was a trend toward increasing systemic corticosteroid use (p for trend = .05). After adjusting for potential confounders, patients were more likely to receive systemic corticosteroids when treated in pediatric EDs than in general EDs (OR = 2.45; 95% CI: 1.26-4.77).
Conclusion. Systemic corticosteroids are under-prescribed for children who present to EDs with acute asthma exacerbations. Pediatric EDs are more likely than general EDs to treat asthma exacerbations with systemic corticosteroids. Differences in the process of care in pediatric ED settings (compared to general EDs) may increase the likelihood of adherence to NIH treatment guidelines.
J Asthma. 2010 Nov 30. [Epub ahead of print]
目的：研究美国哮喘患儿，哮喘急性发作急诊治疗时是否使用全身皮质激素治疗不足（采用当前NIH治疗指南）及与使用全身皮质激素治疗相关的因素。
方法：本研究采用来自2001～2007年全国医院门诊医疗服务调查的数据。研究对象为年龄≤18岁、急症就诊、初始诊断为哮喘(ICD-9-CM编号 493.xx)、接受支气管扩张剂治疗的患者。主要转归为急诊采用全身皮质激素治疗。独立变量包括：患者因素（如：人口统计学指标、保险、发热、入院）、医生因素（如：服务者类型、辅助用药和推荐检测）及系统因素（如：急诊类型、地理位置、就诊时间、季节、年份）。采用多变量回归分析与全身皮质激素治疗相关的因素。
结果：因急性哮喘急诊就诊的儿童患者中，仅63%的患者使用全身激素治疗。整个研究期内，有全身皮质激素使用增加的趋势（p =0.05）。对潜在的混杂因素进行控制后，与普通急诊相比，儿科急诊更可能采用全身皮质激素治疗（OR = 2.45; 95% CI: 1.26-4.77）。
结论：因哮喘恶化而急诊就诊的儿童患者，全身皮质激素治疗使用不足。与普通急诊相比，儿科急诊更可能采用全身皮质激素来治疗哮喘恶化。因此，与普通急诊相比，儿科急诊医生更可能很好地依从哮喘治疗相关的NIH指南。
（苏楠 审校）
J Asthma. 2010 Nov 30. [Epub ahead of print]
Pediatric Emergency Departments are More Likely Than General Emergency Departments to Treat Asthma Exacerbation With Systemic Corticosteroids.
Bekmezian A, Hersh AL, Maselli JH, Cabana MD.
Department of Pediatrics, University of California, San Francisco.
Abstract
Objective. To determine whether systemic corticosteroids are under-prescribed (as measured by current NIH treatment guidelines) for children in the United States seen in the emergency department (ED) for acute asthma, and to identify factors associated with prescribing systemic corticosteroids.
Methods. We used data from the 2001-2007 National Hospital Ambulatory Medical Care Survey. The study population was children ≤18 years old in the ED with a primary diagnosis of asthma (ICD-9-CM code 493.xx) who received bronchodilator(s). The primary outcome was receipt of a systemic corticosteroid in the ED. Independent variables included patient-level (e.g., demographics, insurance, fever, admission), physician-level (provider type, ancillary medications and tests ordered), and system-level factors (e.g., ED type, geographic location, time of day, season, year). We used multivariable logistic regression techniques to identify factors associated with systemic corticosteroid treatment.
Results. Systemic corticosteroids were prescribed at only 63% of pediatric acute asthma visits to EDs. Over the study period, there was a trend toward increasing systemic corticosteroid use (p for trend = .05). After adjusting for potential confounders, patients were more likely to receive systemic corticosteroids when treated in pediatric EDs than in general EDs (OR = 2.45; 95% CI: 1.26-4.77).
Conclusion. Systemic corticosteroids are under-prescribed for children who present to EDs with acute asthma exacerbations. Pediatric EDs are more likely than general EDs to treat asthma exacerbations with systemic corticosteroids. Differences in the process of care in pediatric ED settings (compared to general EDs) may increase the likelihood of adherence to NIH treatment guidelines.
J Asthma. 2010 Nov 30. [Epub ahead of print]
