Quality of Care for Common Pediatric Respiratory Illnesses in United States Emergency Departments: Analysis of 2005 National Hospital Ambulatory Medical Care Survey Data

Abstract

OBJECTIVE. The goal was to measure US emergency department performance in the pediatric care of asthma, bronchiolitis, and croup, by using systematically developed quality indicators. METHODS. Data on visits to emergency departments by children 1 to 19 years of age with moderate/severe asthma, 3 months to 2 years of age with bronchiolitis, and 3 months to 3 years of age with croup from the 2005 National Hospital Ambulatory Medical Care Survey, with a nationally representative sample of US patients, were analyzed. We used national rates of use of corticosteroids, antibiotics, and radiographs as our main outcome measures. RESULTS. Physicians prescribed corticosteroids in 69% of the estimated 405 000 annual visits for moderate/severe asthma and in 31% of the estimated 317 000 annual croup visits. Children with bronchiolitis received antibiotics in 53% of the estimated 228 000 annual visits. Physicians obtained radiographs in 72% of bronchiolitis visits and 32% of croup visits. CONCLUSIONS. Physicians treating children with asthma, bronchiolitis, and croup in US emergency departments are underusing known effective treatments and overusing ineffective or unproven therapies and diagnostic tests.