Recent studies have shown that discharging to home an emergency department (ED) patient with croup if the patient is clinically stable 3 to 4 hours after being treated with nebulized racemic epinephrine (NRE) is safe and cost effective.
The objective of this study was to determine if EDs in our geographic area are using NRE cost-effectively in the management of croup.
Asurvey was mailed to the ED medical directors of 23 hospitals in Ohio, Kentucky, and Indiana within a 150-mile radius of our teaching/referral children's hospital.
All the hospitals surveyed were community hospitals with EDs and in-patient pediatric units.
The survey presented a 2-year-old with a croup-like illness and stridor at rest whom they have just treated with NRE and dexamethasone.
The medical directors were asked what their disposition would be once the NRE therapy has been completed : automatically admit, transfer, discharge immediately, or observe for 3 to 4 hours and if stable at that time discharge to home with follow-up.
Seven (30%) indicated they would automatically admit, compared with 16 (70%) who indicated they would observe for 3 to 4 hours (P=06).
This article discusses potential reasons that 30% of the ED medical directors in our geographic area would automatically admit these patients rather than observe for signs of improvement that could lead to safe discharge and resultant cost savings.
Mots-clés Pascal : Laryngotrachéobronchite, Virose, Infection, Epinéphrine(médicament), Chimiothérapie, Catécholamine, Agoniste, Récepteur alpha-adrénergique, Aérosol, Etats Unis, Amérique du Nord, Amérique, Service urgence, Sortie hôpital, Dexaméthasone, Antiinflammatoire, Economie santé, Traitement, Protocole thérapeutique, Enfant, Homme, Mâle, Corticostéroïde, ORL pathologie, Appareil respiratoire pathologie
Mots-clés Pascal anglais : Laryngotracheobronchitis, Viral disease, Infection, Epinephrine(drug), Chemotherapy, Catecholamine, Agonist, alpha-Adrenergic receptor, Aerosols, United States, North America, America, Emergency department, Hospital discharge, Dexamethasone, Antiinflammatory agent, Health economy, Treatment, Therapeutic protocol, Child, Human, Male, Corticosteroid, ENT disease, Respiratory disease
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0124154
Code Inist : 002B02B09A. Création : 22/06/1998.