Is the medication given to children with acute asthma exacerbation, in Scotland, effective on improving physiological markers? A Quantitative secondary data analysis

Abstract

Purpose: To investigate the effectiveness of hospital based treatment for children admitted to hospital with acute asthma exacerbation and the adherence to hospital's discharge criteria. Design: A quantitative secondary data analysis of within and between group comparisons to evaluate practice implementation. Participants: Medical notes from 34 children aged 5-14 admitted with acute asthma at the Royal Hospital for Sick Children (RHSC), in Scotland, during November 2014. Methods: Medical notes were divided in two groups (n=28 and n=6) according to the medication received while in hospital. Means of admission and discharge values for the outcomes were compared. Outcome measures: Primary: Heart rate (HR), respiratory rate (RR), temperature, oxygen saturation (SaO2), and Peak expiratory flow (PEF) values. Secondary: Hospital's discharge criteria (inhaler dose=4 hourly, SaO2>92, temp <38). Results: The treatment given in both groups was effective in increasing SaO2 and reducing temperature, RR and HR values; First group: HR (95%CI: -38.09 to -17.48), RR (Z= -3.751, p<0.0001), temperature (95%CI: -0.7816 to -0.09693) and Sao2 (95%CI: -1.254 to3.460); Second group: HR (95%CI: -47.84 to -18.16), RR (95%CI: -16.03 to -4.637), temperature (95%CI: -2.554 to 0.053) and SaO2 (95%CI: -2.366 to7.366). Discharge criteria were met in 33 out of 34 patients (97%). Conclusion: The hospital adhered to recommendations made in previous audit and medication prevalence abides by the current evidence in the literature. The hospital failed to provide PEF records, which is essential for screening asthma severity. Further research is necessary to explain the increased number of asthma related admissions, investigate the lack of PEF records and investigate literature inconsistencies regarding the use of ipratropium in children with acute asthma.