No registrations found.
ID
Source
Brief title
Health condition
Asthma
Sponsors and support
Intervention
Outcome measures
Primary outcome
Difference in admission time for children with acute asthma who are treated according to the current nurse-driven pathway or the new pathway with adjusted treatment thresholds for patients who need supplemental oxygen.
Secondary outcome
-number of bronchodilator adminstrations per patient,
-the number of deviations from the pathway; administration of bronchodilators when not indicated or when bronchodilators were indicated but not administered.
-number or assessments by attending physician
-number of patients excluded because they needed treatment with intravenous albuterol
-number of re-admission within one week
-association between heart rate and the total CAS en individual items of CAS
-difference between groups in administration of intravenous magensiumsulphate
-difference between groups in transfer to pediatric intensive care unit
Background summary
The administration of bronchodilators for acute asthma is based on serial assessments of the patient’s respiratory status. In daily practice, this may result in variability and/or delay in the decision-making process to wean or intensify bronchodilator administration. We aim to improve the quality of care by standardizing inpatient asthma care and reduce the length of stay. We developed an asthma score that does not require auscultation of the lungs. This innovative asthma score was adapted from the physical findings in pediatric asthma scores validated previously. We recently demonstrated that this childhood asthma score (CAS) could accurately predict the bronchodilator nebulization requirement compared to the routine clinical judgment of the attending physician to administer bronchodilators. Subsequently, we conducted a study to implement a nurse-driven clinical pathway based on our innovative asthma score. This pathway included standardized respiratory assessments and a protocol for the nursing staff to administer bronchodilators without a specific order from the physician. Length of stay was significantly reduced compared to the historical standard practice. Patient safety was not compromised.
The results of our previous study encourage us to further evaluate and adapt the pathway for patients who need supplemental oxygen. In this randomised study, length of stay and safety for patients who need supplemental oxygen treated according to the current pathway will be compared to a pathway with adjusted treatment thresholds.
Study objective
A clinical pathway with adjusted treatment thresholds for patients who need supplemental oxygen will reduce the number of unnecessary bronchodilator administrations.
Study design
Length of hospital admission will be determined by obtaining date and time of admission and discharge from the electronic record form
Asthma scores are calculated by a validated Excel software algorithm and automatically registered in an Excel database.
All relevant data for the secondary outcomes will be obtained from the electronic record form one week after discharge to be able to register readmissions for acute asthma
Intervention
The intervention comprises adjusted treatment thresholds for patients with acute asthma who need supplemental oxygen.
Inclusion criteria
-children 2-18 years of age admitted for acute asthma
-treatment for acute asthma according to current dutch guideline
-supplemental oxygen use, low flow or high flow
Exclusion criteria
-severe acute asthma for which intravenous albuterol is indicated
-unstable heart disease
-cystic fbrosis or other chronich or congenital lung disease
-any neurological disease
-any muscular disease
Design
Recruitment
IPD sharing statement
Plan description
Followed up by the following (possibly more current) registration
No registrations found.
Other (possibly less up-to-date) registrations in this register
No registrations found.
In other registers
| Register | ID |
|---|---|
| NTR-new | NL9745 |
| Other | METC UMCG : METc 2021/179 |