Document Detail

Factors associated with delayed use or nonuse of systemic corticosteroids in emergency department patients with acute asthma.
MedLine Citation:
PMID:  19852196     Owner:  NLM     Status:  MEDLINE    
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.
Chu-Lin Tsai; Brian H Rowe; Ashley F Sullivan; Carlos A Camargo
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Publication Detail:
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:
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:
Created Date:  2009-10-26     Completed Date:  2009-12-04     Revised Date:  2013-09-17    
Medline Journal Info:
Nlm Unique ID:  9503580     Medline TA:  Ann Allergy Asthma Immunol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  318-24     Citation Subset:  IM    
Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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MeSH Terms
Acute Disease
Adrenal Cortex Hormones / administration & dosage*
Age Factors
Asthma / drug therapy*
Cohort Studies
Drug Administration Schedule
Emergency Service, Hospital
Retrospective Studies
Sex Factors
United States
Urban Population
Young Adult
Grant Support
Reg. No./Substance:
0/Adrenal Cortex Hormones

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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