ABSTRACT
BACKGROUND: Although the overuse of antibiotics and underuse of bronchodilators for treatment of acute bronchitis is well known, few studies have analyzed these trends in the emergency department (ED). STUDY OBJECTIVES: To characterize the antibiotic and bronchodilator prescribing practices of physicians at two academic EDs in the diagnosis of acute bronchitis, and to identify factors that may or may not be associated with these practices. METHODS: A computer database was searched retrospectively for all patients with an ED discharge diagnosis of acute bronchitis, and analyzed, looking at the frequency of antibiotic prescriptions, the class of antibiotic prescribed, and several other related factors including age, gender, chief complaint, duration of cough, and comorbid conditions. RESULTS: During the study period, there were 836 cases of acute bronchitis in adults. Of these, 622 (74.0%) were prescribed antibiotics. Of those prescribed antibiotics, 480 (77.2%) were prescribed broad-spectrum antibiotics. Using multivariate analysis (odds ratio, 95% confidence interval), antibiotics were prescribed significantly more often in patients aged 50 years or older (1.7, 1.2-2.5) and in smokers (1.5, 1.0-2.2). Of patients without asthma, 346 (49.9%) were discharged without a bronchodilator, and 631 (91.1%) were discharged without a spacer device. CONCLUSION: Antibiotics are over-prescribed in the ED for acute bronchitis, with broad-spectrum antibiotics making up the majority of the antibiotics prescribed. Age ≥50 years and smoking are associated with higher antibiotic prescribing rates.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Bronchitis/drug therapy , Bronchodilator Agents/therapeutic use , Drug Prescriptions , Emergency Service, Hospital , Practice Patterns, Physicians' , Adult , Age Factors , Asthma/complications , Asthma/drug therapy , Bronchitis/complications , Confidence Intervals , Female , HIV Infections/complications , HIV Infections/drug therapy , Hospitals, University , Humans , Inappropriate Prescribing , Male , Middle Aged , Multivariate Analysis , Odds Ratio , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/drug therapy , Retrospective Studies , SmokingABSTRACT
BACKGROUND: Although the treatment of foreign body airway obstruction in adults has been well studied, few data exist on the characterization of prehospital experiences. OBJECTIVES: To describe the frequency, etiologies, and treatments of foreign body airway obstruction in adults in the prehospital setting and to discuss the relative efficacies of treatments and presenting factors that predict overall patient outcome. METHODS: A San Diego County prehospital database was retrospectively reviewed for all adult patients over a 17-month period with data extracted on demographic characteristics, incident outcome, patient disposition, item involved in obstruction, location of episode, initial vital signs, initial level of consciousness, pertinent medical history, treatments initiated by bystanders and paramedics, and response to those treatments. RESULTS: During the study period, there were 513 cases of foreign body airway obstruction in adults. Of these, 17 (3.3%) died. The mean age was 65.0 years, with increasing age correlating with worse outcome. The item causing obstruction varied widely, with medications and meat being the most common items. The Heimlich maneuver was the most commonly used intervention, with an 86.5% rate of patient improvement. Magill forceps proved useful for three cases refractory to the Heimlich maneuver. Presenting vital sign aberrations, particularly with respiratory rate, correlated with poorer patient outcome. CONCLUSIONS: Foreign body airway obstruction represents a true emergency in adults, with a 3.3% mortality rate in the current study. The Heimlich maneuver was used frequently and with good success.
