Acute paediatric asthma treatment in the prehospital setting: a retrospective observational study

ObjectivesTo describe the incidence of and patterns of 'escalated care' (care in addition to standard treatment with systemic corticosteroids and inhaled bronchodilators) for children receiving prehospital treatment for asthma. DesignRetrospective observational study. SettingState-wide ambulance service data (Ambulance Victoria in Victoria, Australia, population 6.5 million) ParticipantsChildren aged 1-17 years and given a final diagnosis of asthma by the treating paramedics and/or treated with inhaled bronchodilators from 1 July 2019 to 30 June 2020. Primary and secondary outcome measuresWe classified 'escalation of care' as parenteral administration of epinephrine, or provision of respiratory support. We compared clinical, demographic and treatments administered between those receiving and not receiving escalation of care. ResultsParamedics attended 1572 children with acute exacerbations of asthma during the 1 year study period. Of these, 22 (1.4%) had escalated care, all receiving parenteral epinephrine. Patients with escalated care were more likely to be older, had previously required hospital admission for asthma and had severe respiratory distress at initial assessment.Of 1307 children with respiratory status data available, at arrival to hospital, the respiratory status of children had improved overall (normal/mild respiratory distress at initial assessment 847 (64.8%), normal/mild respiratory distress at hospital arrival 1142 (87.4%), p<0.0001). ConclusionsMost children with acute exacerbations of asthma did not receive escalated therapy during their pre-hospital treatment from ambulance paramedics. Most patients were treated with inhaled bronchodilators only and clinically improved by the time they arrived in hospital.

Automated summary

This retrospective observational study analyzed ambulance service data in Victoria, Australia to examine the escalated care for children with acute exacerbations of asthma. The results showed that most patients received inhaled bronchodilators only during pre-hospital treatment and showed improvement upon arrival at the hospital.