Receipt of systemic corticosteroids during asthma visits to US emergency departments, 2007-2009.

BACKGROUND: National Asthma Education and Prevention Program recommended emergency department (ED) asthma treatment includes both providing systemic corticosteroids in the ED and a steroid prescription at discharge.

OBJECTIVE: To examine the prevalence of three types of substandard ED asthma care-providing a discharge prescription only, providing corticosteroids in the ED only, and providing neither- and how care varies with exacerbation severity.

METHODS: We used the National Hospital Ambulatory Medical Care Survey-Emergency Department (NHAMCS-ED) (2007, 2008, and 2009) to identify ED asthma visits (International Classification of Diseases-9(th) Revision Clinical Modification (ICD-9-CM codes 493.xx)) for patients aged 1 to <65 years. The primary outcome was the percent of visits receiving each type of substandard care, both overall and by exacerbation severity. Multinomial logistic regressions with predictive margins were used to obtain estimates adjusted for patient, visit, and hospital characteristics.

RESULTS: For 27.1% (confidence interval (CI): 24.0-30.2%) of visits, patients received corticosteroids both in the ED and as a discharge prescription. A discharge prescription only was provided for 12.3% of visits (CI: 10.2-14.6%), corticosteroids were provided in the ED only for 18.2% (CI: 15.6-21.2%), and no corticosteroids were provided for 42.4% (CI: 38.8-46.2%). Even among visits by patients with abnormal overall respiratory status (fast respiratory rates, pulse oximetry values <97%, or both), only 32.3% (CI: 27.8-36.8) were provided corticosteroids both in the ED and as a prescription, while the remainder received some type of substandard care. Adjusted and unadjusted results were similar.

CONCLUSIONS: Substandard ED asthma care is common, even among visits by patients with more severe asthma exacerbations.