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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.



Li P, To T, Parkin PC, Anderson GM, Guttmann A. Arch Pediatr Adolesc Med. 2012; 166(9):834-40.

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