The effect of acute and chronic asthma severity on pediatric emergency department utilization

OBJECTIVE. Our goal was to teach emergency department (ED) physicians how to use standardized criteria for diagnosing and classifying asthma severity and to describe the patterns of pediatric ED utilization of these criteria for classification of both acute and chronic severity. METHOD. A health care provider education module was developed and implemented in 4 participating EDs in southeast Texas to educate ED physicians and health care providers on the diagnosis and acute and chronic severity classification of pediatric asthma patients. We undertook both retrospective ( medical chart extraction) and prospective surveillance over a 2-year period of all children presenting to 1 of 4 EDs with acute asthma. Demographic characteristics, classification of severity, health care resource utilization, and primary physician contact information were collected. RESULTS. The health care provider educational intervention was provided for 84 different physicians. A subset of 16 physicians was randomly tested preintervention and postintervention. Mean mock-scenario scores at 2 weeks showed an improvement of 55.6%, which was sustained at retesting at 6 months. Over the 2-year period, 6222 individual pediatric ED encounters were entered into the surveillance database. The median age of presentation was 5 years. More than 32% of the patients in the study were uninsured. The majority of the patients in each category had asthma of mild severity: mild intermittent chronic (58.7%) and mild acute (53.9%). CONCLUSIONS. Physicians who completed a health care provider education module learned to effectively diagnose asthma and recognize standardized acute and chronic severity classifications. The majority of children with asthma who presented to the Texas Emergency Department Asthma Surveillance project's participating EDs were classified as having mild acute severity and mild intermittent chronic disease. Almost one third of these patients did not have health insurance.