Safe Discharge for Children with Asthma

Safe Discharge for Children with Asthma

Asthma is one of the most common pediatric respiratory conditions, and a frequent reason for which children are seen in the emergency department. Many of these children can be appropriately treated within the emergency department and safely discharged home. National evidence-based guidelines suggest that a preliminary standardized assessment, timely treatment with one steroid and up to three bronchodilators, and post-treatment assessment can help prevent the child from being hospitalized from the emergency department unnecessarily. MEDIC has adopted these recommendations to guide the emergency department care of children with uncomplicated asthma, facilitate more standardized management, improve the quality of the care delivered, and increase the likelihood of safe discharge to home.

MEDIC Safe Discharge for Children with Asthma Toolkit

Key References

  • Abaya R, et al. Improving efficiency of pediatric emergency asthma treatment by using metered dose inhaler. J Asthma. 2019 Oct;56(10):1079-1086.
  • Alnaji F, et al. PRAM score as predictor of pediatric asthma hospitalization. Acad Emerg Med. 2014 Aug;21(8):872-8.
  • Arnold DH, et al. The RAD score: a simple acute asthma severity score compares favorably to more complex scores. Ann Allergy Asthma Immunol. 2011 Jul;107(1):22-8. Epub 2011 Apr 22.
  • Bhogal SK, et al. Early administration of systemic corticosteroids reduces hospital admission rates for children with moderate and severe asthma exacerbation. Ann Emerg Med. 2012 Jul;60(1):84-91.e3.
  • Ducharme FM, et alThe Pediatric Respiratory Assessment Measure: A Valid Clinical Score for Assessing Acute Asthma Severity from Toddlers to Teenagers. J of Pediatrics 2008.
  • Five Things Physicians and Patients Should Question. American Academy of Pediatrics Section on Pediatric Pulmonary & Sleep Medicine, Choosing Wisely. 2020 Aug. https://www.choosingwisely.org/societies/american-academy-of-pediatrics-section-on-pediatric-pulmonology-and-sleep-medicine/.
  • Gorelick M, et al. Performance of a novel clinical score, the Pediatric Asthma Severity Score (PASS), in the evaluation of acute asthma. Acad Emerg Med. 2004 Jan;11(1):10-8.
  • Gorelick M, et al. Predicting need for hospitalization in acute pediatric asthma. Pediatr Emerg Care. 2008 Nov;24(11):735-44.
  • Gouin S, et al. Prospective evaluation of two clinical scores for acute asthma in children 18 months to 7 years of age. Acad Emerg Med. 2010 Jun;17(6):598-603.
  • National Asthma Education and Prevention Program. Expert panel report 3 (EPR 3): Guidelines for the diagnosis and management of asthma-summary report 2007. J Allergy Clin Immunol. 2007;120:S94-S138. This document can also be found herehttps://www.nhlbi.nih.gov/health-topics/guidelines-for-diagnosis-management-of-asthma.
  • Zahran HS, et al. Vital Signs: Asthma in Children – United States, 2001-2016. MMWR Morb Mortal Wkly Rep. 2018 Feb 9;67(5):149-155.
  • Zemek R, et al. Triage nurse initiative of corticosteroids in pediatric asthma is associated with improved emergency department efficiency. Pediatrics. 2012 Apr;129(4):671-80.