| Factors associated with delayed use or nonuse of systemic corticosteroids in emergency department patients with acute asthma. | |
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MedLine Citation:
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PMID: 19852196 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Little is known about factors associated with systemic corticosteroid (SC) use in emergency department (ED) patients with acute asthma. OBJECTIVE: To determine the patient and system factors associated with delayed use or nonuse of SCs in the ED. METHODS: We analyzed the asthma component of the National Emergency Department Safety Study. Patients with acute asthma in 62 urban EDs in 23 US states between 2003 and 2006 were identified. The primary outcome measure was the pattern of SC use in the ED, which was categorized as timely use (< or = 60 minutes), delayed use (> 60 minutes), or nonuse. Multinomial logistic regression was performed to identify factors associated with delayed use or nonuse of SCs. RESULTS: A total of 2,559 of 3,798 patients with acute asthma (67.4%) received SCs. Of these, the median door-to-SC time was 62 minutes (interquartile range, 35-100 minutes), with 1,319 patients (51.5%) having delayed SC treatment. Nonuse of SCs was largely explained by markers of asthma exacerbations (never intubated for asthma, lower respiratory rate, and higher oxygen saturation). In contrast, in addition to these factors, delayed SC treatment was associated with age of 40 years or older, female sex, longer duration of symptoms, ED presentation between 8 AM and 11:59 PM, and ED with a longer average patient wait time. CONCLUSIONS: Physicians in the ED seem to appropriately administer SCs to higher-acuity asthmatic patients; however, the additional nonmedical factors represent opportunities to improve the timeliness of SC treatment in the ED. |
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Authors:
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Chu-Lin Tsai; Brian H Rowe; Ashley F Sullivan; Carlos A Camargo |
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Publication Detail:
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Type: Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't; Research Support, U.S. Gov't, P.H.S. |
Journal Detail:
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Title: Annals of allergy, asthma & immunology : official publication of the American College of Allergy, Asthma, & Immunology Volume: 103 ISSN: 1081-1206 ISO Abbreviation: Ann. Allergy Asthma Immunol. Publication Date: 2009 Oct |
Date Detail:
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Created Date: 2009-10-26 Completed Date: 2009-12-04 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 9503580 Medline TA: Ann Allergy Asthma Immunol Country: United States |
Other Details:
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Languages: eng Pagination: 318-24 Citation Subset: IM |
Affiliation:
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Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Acute Disease Adrenal Cortex Hormones / administration & dosage* Adult Age Factors Asthma / drug therapy* Cohort Studies Drug Administration Schedule Emergency Service, Hospital Female Humans Male Retrospective Studies Sex Factors United States Urban Population Young Adult |
| Grant Support | |
ID/Acronym/Agency:
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R01 HL-84401/HL/NHLBI NIH HHS; R01 HS-13099/HS/AHRQ HHS |
| Chemical | |
Reg. No./Substance:
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0/Adrenal Cortex Hormones |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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