ABSTRACT
OBJECTIVE: To determine if the addition of ipratropium bromide to the emergency department (ED) treatment of childhood asthma reduces time to discharge, number of nebulizer treatments before discharge, and the rate of hospitalization. METHODS: Patients >12 months of age were eligible if they were to be treated according to a standardized ED protocol for acute asthma with nebulized albuterol (2.5 mg/dose if weight <30 kg, otherwise 5 mg/dose) and oral prednisone or prednisolone (2 mg/kg up to 80 mg). Subjects were randomized to receive either ipratropium (250 microg/dose) or normal saline (1 mL/dose) with each of the first three nebulized albuterol doses. Further treatment after the first hour was determined by physicians blinded to subject group assignment. Records were reviewed to determine the length of time to discharge home from the ED, number of doses of albuterol given before discharge, and the number of patients admitted to the hospital. RESULTS: Four hundred twenty-seven patients were randomized to ipratropium or control groups; these groups were similar in all baseline measures. Among patients discharged from the ED, ipratropium group subjects had 13% shorter treatment time (mean, 185 minutes, vs control, 213 minutes) and fewer total albuterol doses (median, three, vs control, four). Admission rates did not differ significantly (18%, vs control, 22%). CONCLUSIONS: The addition of three doses of ipratropium to an ED treatment protocol for acute asthma was associated with reductions in duration and amount of treatment before discharge.
Subject(s)
Asthma/drug therapy , Bronchodilator Agents/therapeutic use , Emergency Treatment , Ipratropium/therapeutic use , Administration, Inhalation , Administration, Oral , Adolescent , Albuterol/therapeutic use , Anti-Inflammatory Agents/therapeutic use , Child , Child, Preschool , Drug Therapy, Combination , Emergency Service, Hospital , Emergency Treatment/standards , Female , Humans , Infant , Length of Stay , Male , Prednisolone/therapeutic use , Prednisone/therapeutic useSubject(s)
Ambulatory Care , Fever/therapy , Hospitalization , Body Temperature/physiology , Fever/physiopathology , Humans , Infant , Infant, Newborn , Length of StayABSTRACT
Injury is the leading cause of death in children in the United States, and it is a leading reason for children to need emergent medical attention. The care of injured and ill children can best be coordinated through a comprehensive system of Emergency Medical Services for Children (EMS-C). This article reviews childhood injury epidemiology, details the history and components of EMS-C systems, and discusses areas for improvement of and individual involvement in EMS-C.
Subject(s)
Child Health Services/organization & administration , Comprehensive Health Care/organization & administration , Emergency Medical Services/organization & administration , Wounds and Injuries/therapy , Adolescent , Cause of Death , Child , Child, Preschool , Health Priorities , Health Services Accessibility , Humans , Incidence , Infant , Infant, Newborn , Primary Prevention , Quality Assurance, Health Care , Research , United States/epidemiology , Value of Life , Wounds and Injuries/diagnosis , Wounds and Injuries/economics , Wounds and Injuries/epidemiologyABSTRACT
This study sought to determine (1) the association between passive smoke exposure and acute symptoms in asthmatic children and (2) the association between parental report and objective measures of passive smoke exposure. Asthmatic children ages 3 to 11 were eligible for the study, which involved measurement of smoke exposure by questionnaire and by urine sample at a time of an acute asthma attack and then later when the child was symptom-free. High levels of passive smoke exposure were detected at both times in most children. Parental report of passive smoke exposure correlated with urinary measure of exposure.
