Quality of care for common pediatric respiratory illnesses in United States emergency departments: analysis of 2005 National Hospital Ambulatory Medical Care Survey Data.

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.