Practice Pattern Variation in the Care of Children With Acute Asthma

Acad Emerg Med. 2016 Feb;23(2):166-70. doi: 10.1111/acem.12857. Epub 2016 Jan 14.


Objectives: Pediatric asthma is a highly prevalent disease, affecting over 7 million U.S. children and accounting for 750,000 annual emergency department (ED) visits. Guidelines from the National Asthma Education and Prevention Program recommend limited use of chest radiography (CXR), complete blood counts (CBCs), and antibiotics when managing acute exacerbations of asthma. However, studies suggest frequent overutilization of these resources. The objective was to evaluate differences between pediatric and general EDs in rates of CXRs, CBCs, and use of antibiotics for pediatric asthma exacerbations.

Methods: This was a repeated cross-sectional analysis of data from the National Hospital Ambulatory Medical Care Survey from 2000 through 2010 of CXR, CBCs, and antibiotics during ED visits for pediatric acute asthma exacerbations. Multivariable logistic regression was performed to identify differences in asthma management by ED type (pediatric vs. general) after adjusting for demographic covariates.

Results: There were 3,313 observations, representing an estimated 10.9 million (95% confidence interval [CI] = 9.7 to 12.1 million) ED visits for acute asthma without bacterial coinfection. Of these, 17.4% occurred in pediatric EDs. Multivariable logistic regression revealed that visits to pediatric EDs were less likely to include CXRs (adjusted odds ratio [AOR] = 0.39; 95% CI = 0.25 to 0.60), CBCs (AOR = 0.42; 95% CI = 0.22 to 0.80), and antibiotics (AOR = 0.50; 95% CI = 0.31 to 0.82) after adjustment for race/ethnicity, triage level, academic ED, metropolitan statistical area, and geographic region.

Conclusions: There are substantial differences in diagnostic testing and antibiotic usage for management of acute exacerbations of asthma by ED type, suggesting potential resource overuse in general EDs. Future studies should focus on evaluating the effect of quality improvement efforts for ED asthma management.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Acute Disease
  • Anti-Bacterial Agents / administration & dosage*
  • Anti-Bacterial Agents / therapeutic use
  • Asthma / diagnostic imaging*
  • Asthma / drug therapy*
  • Blood Cell Count
  • Child
  • Child, Preschool
  • Cross-Sectional Studies
  • Emergency Service, Hospital / statistics & numerical data*
  • Female
  • Guideline Adherence
  • Health Care Surveys
  • Hospitals, General / statistics & numerical data*
  • Hospitals, Pediatric / statistics & numerical data*
  • Humans
  • Male
  • Odds Ratio
  • Practice Guidelines as Topic
  • Practice Patterns, Physicians' / statistics & numerical data
  • Radiography, Thoracic
  • United States


  • Anti-Bacterial Agents