Association between evidence-based standardized protocols in emergency departments with childhood asthma outcomes: a Canadian population-based study

Objective — To determine whether children treated in emergency departments (EDs) with evidence-based standardized protocols (EBSPs) containing evidence-based content and format had lower risk of hospital admission or ED return visit and greater follow-up than children treated in EDs with no standardized protocols in Ontario, Canada.

Design — Retrospective population-based cohort study of children with asthma. We used multivariable logistic regression to estimate risk of outcomes.

Setting — All EDs in Ontario (N = 146) treating childhood asthma from April 2006 to March 2009.

Participants — 31,138 children (aged 2 to 17 years) with asthma.

Main Exposure — Type of standardized protocol (EBSPs, other standardized protocols, or none). 

Main Outcome Measures — Hospital admission, high-acuity 7-day return visit to the ED, and 7-day outpatient follow-up visit.

Results — The final cohort made 46 510 ED visits in 146 EDs. From the index ED visit, 4211 (9.1%) were admitted to the hospital. Of those discharged, 1778 (4.2%) and 7350 (17.4%) had ED return visits and outpatient follow-up visits, respectively. The EBSPs were not associated with hospitalizations, return visits, or follow-up (adjusted odds ratio, 1.17 [95% CI, 0.91–1.49]; adjusted odds ratio, 1.10 [95% CI, 0.86–1.41]; and adjusted odds ratio, 1.08 [95% CI, 0.87–1.35], respectively).

Conclusions — The EBSPs were not associated with improvements in rates of hospital admissions, return visits to the ED, or follow-up. Our findings suggest the need to address gaps linking improved processes of asthma care with outcomes.