Erin Hulfish, MD
Stony Brook Children's Hospital
Stony Brook, NY
Disclosure information not submitted.
Lauren Maloney, MD
Assistant Professor of Emergency Medicine
Stony Brook University Hospital
Stony Brook, New York, United States
Disclosure information not submitted.
Title: Evaluation of Pediatric Asthma Scores of Those Admitted from the Emergency Medicine Transport Team
Introduction: Asthma exacerbation is one of the most common causes for admission in both pediatric floors and Pediatric Intensive Care Unit (PICU). Many institutions have implemented protocol driven approach to asthma management. Our asthma protocol uses a validated Pediatric Asthma Score (PAS) to categorize patients into mild, moderate, or severe based on clinical parameters, paired with algorithms that dictates management. Since its launch in December of 2017, our protocol and assessment has only been applied to our inpatient and emergency room patients. We aim to evaluate the scores of the pediatric patients on admission transported by our inter-hospital EMS team, determine if there was a change in disposition of any patient admitted with status asthmaticus in the first four hours of admission and what, if any, medical or respiratory therapy interventions occurred pre-hospital.
Methods: This is an IRB approved retrospective chart review conducted between December 1st, 2017 - July 1, of 2021. All patients greater than or equal to 2 years of age and less than 18 years of age admitted to the PICU or acute care unit (ACU) from our inter-hospital transport team with an admission diagnosis of asthma or wheezing were included. Those with co-morbid pre-existing conditions such as congenital pulmonary or cardiac disease were excluded from review. Analysis of the data was done with SPSS system.
Results: Forty-four patients were included in the study, 22 children were admitted directly to the PICU and 22 patients were admitted directly to the ACU. There were no significant differences in the demographics between those admitted to the ACU vs the PICU. There was a significant difference, p< 0.05, between the median PAS between those admitted to the ACU vs the PICU 5.56 vs 8.81 respectively. Of those admitted to the PICU, only 50% had initial PAS requiring PICU level of care. Those requiring admission to PICU also had higher incidence of requiring medication during EMS transport 77% vs 22% p < 0.05.
Conclusions: While the initial PAS were higher in those admitted directly to the PICU, the score for 50% of those patients, placed them on the moderate asthma pathway and thus could have been admitted directly to the ACU. Next steps will include education and implementation of the PAS scoring system by EMS.