Abstract
Background:
One of the most common reasons for pediatric emergency department (ED) visits is due to pediatric asthma. In response to the COVID-19 pandemic, in 2020 we modified our treatment of moderate asthma patients in our pediatric ED. Patients who previously received 1-3 albuterol/ipratropium nebulized treatments based on response, now receive 1-3 albuterol MDI treatments based on response driven by an asthma score. We aimed to determine if the change in albuterol delivery method and removal of ipratropium treatments had an impact on length of stay (LOS) or admission rate (AR) in our pediatric population.
Methods:
In an IRB approved retrospective analysis, we reviewed all moderate asthmatic patients seen in the ED in 2019 and 2021. Patients seen in 2020 were excluded due to low volume. Variables for analysis included LOS and AR. We compared continuous variables using student’s t-test and categorical data using chi-square analysis. Confounding factors were reviewed, and included time to steroid, time to first albuterol dose and PICU admission.
Results:
In 2019, 674 moderate asthmatics were seen in the ED and in 2021, 413 moderate asthmatic patients were seen. Between 2019 and 2021 there was no statistically significant change in AR (P = .086) or PICU AR (P = .245) for moderate asthmatics. In 2021, the ED LOS (P < .05), door to steroid (P < .05), and door to first albuterol dose (P < .01) increased when compared to 2019.
Conclusions:
Despite increased time to steroid, first albuterol dose and ED LOS driven by COVID staffing challenges, removing ipratropium and changing albuterol delivery from nebulizer to MDI, did not increase AR of moderate pediatric asthmatic patients in our facility. This evidence suggests that albuterol administration via MDI and discontinuation of ipratropium is a safe and effective management strategy for moderate pediatric asthma. Further research is needed to standardize care for this patient population.
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