Acute asthma in a children's emergency room: a clinical audit and management guideline proposal.

BACKGROUND: Adequate asthma control in children includes optimal medical management of acute exacerbations of the disorder. Asthma guidelines provide critical information and serve as quick reference decision-support material for clinicians. AIM: This clinical audit aimed at evaluating emergency management of acute asthma as well as proposing for use a management protocol, with the view of improving quality of care. METHOD: This is a retrospective audit of the management of acute asthma over 18 months (October 2000-April 2002) Relevant data related to diagnostic and therapeutic procedures in thirty asthmatics were extracted and examined. RESULTS: There were 20 males and 10 females (M:F ratio 2:1). Mean age (range) was 5.9 years (10 months-12.5 years) and mean (range) duration of symptoms prior to presentation was 1.9 days (2 hours-8 days). Trigger factors, current medications, clinical and functional indices of severity of acute asthma were not documented in 73.3%, 93.3% and 96.7% cases respectively. Diagnostic labels used in 28 (93.3%) did not reflect the acute nature or severity of the acute episode. Although nebulized salbutamol and oral corticosteroids were used for 80.0% of cases, aminophylline was frequently prescribed in addition. Discharge medications and instructions, including follow up in the respiratory clinic were not given in 21 (70.0%) and 28 (93.3%) cases respectively. CONCLUSION: This audit noted that the overall management of acute asthma in the emergency room and the documentation of crucial information vital in the acute and long-term care of asthmatics were inadequate. We propose and recommend for use in the Children's Emergency Room, acute asthma management guideline and protocol-based asthma paper records as well as computerization of patient records.