Reduced hospital admissions for asthmatics treated with oral corticosteroids shortly after triage in the emergency department

Wednesday, April 4, 2012 - 15:38
Early identification strategy in the ED needed to identify high priority cases
 
MONTREAL, Canada, April 4, 2012 – Children with moderate or severe asthma attacks who are treated with systemic corticosteroids during the first 75 minutes of triage in the Emergency Department (ED) were 16% less likely to be admitted to hospital. This highlights the importance of adopting a strategy to rapidly identify and begin treating children with moderate or severe asthma attacks directly after triage, according to a team of investigators working at the Sainte-Justine University Hospital Center (UHC), the University of Montreal, McGill University and the Research Institute of the McGill University Health Centre (RI MUHC).
 
“We knew that corticosteroids could help avoid hospital admissions and relapses. However, just how delays between ED admission and administration of the treatment impacted outcomes remained unclear”, says Dr. Sanjit K. Bhogal, the lead author of a new study published in Annals of Emergency Medicine and graduate of the Department of Epidemiology, Biostatistics and Occupational Health at McGill.
 
“Our study demonstrates that, to be effective in preventing hospital admission, treatment with corticosteroids should be administered within 75 minutes of triage, regardless of patient age,” says the senior author Dr. Francine Ducharme, who supervised the study while she was a McGill and RI MUHC researcher based at the Montreal Children’s Hospital.
 
According to Dr. Ducharme, now pediatrician and researcher at Sainte-Justine UHC, “in fact, the earlier the treatment is given within this time frame, the more effective it is, hence the advantage of starting treatment right after triage. Furthermore, beginning early treatment reduces ED stay by almost 45 minutes for patients who will be discharged from the ED.”
 
The challenge now is to ensure that the severity of the asthma attack is flagged at the triage stage in order to initiate treatment immediately. In fact, it seems that patients who are treated “too late” were due, for the most part, to not been given high triage priorities or to physicians not being able to assess them early enough. ED congestion did not significantly impact on the time frame for administering corticosteroids.
 
“Given the findings of the study, the need to implement a nursing strategy that involves identifying the severity of the child’s condition and beginning treatment as soon as a patient arrives in the ED, seemed obvious”, said Dr. Ducharme, who is also clinical epidemiologist at the Sainte-Justine UHC, where the study data were compiled and analyzed. Dr. Ducharme also holds the Academic Chair in Clinical Research and Knowledge Transfer in Childhood Asthma at the Sainte-Justine UHC Research Center and is a full professor in the Faculty of Medicine of the University of Montreal.
 
The pediatric respiratory assessment measure (PRAM) scale, developed by Dr. Ducharme’s team, was used to identify the degree of severity of the asthma attack and to rapidly initiate the severity-specific treatment recommended by asthma guidelines. At the Sainte-Justine UHC, Dr. Ducharme’ s team has now develop a teaching module that will allow training of the triage nurses, ED physicians, and respiratory therapists to implement severity-specific guidelines and, whenever possible, to avoid patients being admitted to hospital.
 
The educational module will be available online by the end of 2012 on the University of Montreal’s website. It is eagerly awaited by health institutions in Ontario and Alberta, as well as in several institutions in the US, which have decided to adopt the proposed treatment protocol based on the PRAM scale and who wish to receive training. The tool is an offspring of the integration of research, education and health care. As such, it will make it possible to transfer the knowledge acquired through the study to the EDs around the world, for the direct benefit of patients and their families.
 
About the study:
 
The article Early Administration of Systemic Corticosteriods Reduces Hospital Admission Rates for Children With Moderate and Severe Asthma Exacerbation appeared in the March 10, 2012 online version of the journal Annals of Emergency Medicine. The data were compiled from 406 children admitted in the MUHC Montreal Children’s Hospital ER who met the study criteria. Data were compiled and analyzed at the Sainte-Justine University Hospital Research Center. The study was fully funded by the Research Institute of the McGill University Health Centre (RI MUHC). Both institutions are in part funded by the Fonds de recherche du Québec - Santé (FRQS).
 
About McGill University
 
Founded in Montreal, Que., in 1821, McGill is Canada’s leading post-secondary institution. It has two campuses, 11 faculties, 11 professional schools, 300 programs ofstudy and more than 36,000 students, including 8,300 graduate students. McGill attracts students from over 150 countries around the world, with more than 7,200 international students making up 20 per cent of the student body. Almost half of McGill students claim a first language other than English, including more than 6,200 francophones.www.mcgill.ca
 
The Research Institute of the McGill University Health Centre (RI MUHC) is a world-renowned biomedical and health-care hospital research centre. Research is organized by eleven research axes. Located in Montreal, Quebec, Canada, the Institute is the research arm of the McGill University Health Centre (MUHC) affiliated with the Faculty of Medicine at McGill University. The Institute supports over 600 researchers, over 1,200 graduate students and post-docs and fellows devoted to a broad spectrum of fundamental and clinical research. Over 1,800 clinical research studies are conducted within our hospitals each year. The Research Institute of the MUHC is supported in part by the Fonds de recherche du Québec - Santé (FRQS). www.muhc.ca/research/

About the CHU Sainte-Justine Research Center
 
The Sainte-Justine University Hospital Research Center is a leading mother-child research institution affiliated with the Université de Montréal. It brings together more than 1200 people, including over 200 researchers and 450 graduate and post-graduate students who carry out fundamental, clinical, translational, and evaluative research on mother and child health. Research work falls under six research axes, namely Health Outcomes; Brain Diseases; Musculoskeletal Diseases and Movement Sciences; Viral and Immune Disorders and Cancers; Fetomaternal and Neonatal Pathologies; and Metabolic Health. It is focused on finding innovative prevention means, faster and less invasive treatments, as well as personalized approaches to medicine. The Center is part of the Sainte-Justine University Hospital Centre, which is the largest mother-child centre in Canada and second most important in North America. For more information, please visit: www.chu-Sainte-Justine.org/research/
 
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Flavie Côté
Senior consultant, Media relations
Université de Montréal
514.343.7704