Children with asthma in the emergency department: Spectrum of disease, variation with ethnicity, and approach to treatment

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Abstract
The role of the pediatric emergency department (ED) in the management of acute asthma was assessed by examining patterns of referrals, admissions, clinical patient evaluation, laboratory tests ordered, and treatment instituted. The functioning of the attending physicians with different degrees of seniority was also evaluated. One thousand thirty-six children with acute asthma (5.3% of all visits) were admitted to the ED during 1990. The mean age was 5.5 years, and the male to female ratio was 2.6:1. Fifty percent of the patients reported atopic disease in their immediate family, and upper respiratory tract infection preceding the attack was reported in 27% of patients. Significant differences were observed between Arab and Jewish patients: more Arab patients presented after physician referral (90 vs 33%) in morning hours (43 vs 26%), and after a longer duration of symptoms. Experienced physicians ordered fewer laboratory tests and treated the patients less aggressively than junior physicians. Patients treated by senior physicians stayed less time in the ED, and a smaller proportion of patients was hospitalized (4 vs 19%). Patients admitted by senior physicians had a longer period of hospitalization (4.7 vs 1.2 days). This study shows that ethnicity influenced the pattern of utilization of the ED and that the approach to care differed among junior and senior physicians.

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