Management of Paediatric Acute Asthma in a Metropolitan Emergency Department: A Retrospective Audit.

AIM: To evaluate adherence to the Sydney Children's Hospital Network (SCHN) Asthma-Acute Management Practice Guideline in the management of paediatric patients presenting to a metropolitan emergency department (ED).

METHODS

A cross-sectional retrospective audit of 153 paediatric ED presentations with acute asthma between March 2023 and February 2024 was conducted. Data extracted from electronic medical records included demographics, documented asthma severity, investigations, treatment, length of stay and discharge planning. Asthma severity was inferred retrospectively from documentation, which was often incomplete, limiting interpretation of patient management. Outcomes were compared with SCHN guideline recommendations. Data were analysed descriptively using means and proportions, with subgroup comparisons by admission status and severity classification.

RESULTS

Of 153 presentations, 56 (36.6%) resulted in admission. Documentation of key severity parameters was frequently incomplete, including speech (78%) and cyanosis (69%). Chest X-rays were performed in 34.6% of cases. Mean bronchodilator burst duration exceeded guideline recommendations (salbutamol 46.7 min; ipratropium 47.7 min). Systemic corticosteroids were administered in 92% of patients, with appropriate dosing in 63%. Among 27 severe/life-threatening cases, 8 (29.6%) received intravenous magnesium sulphate. Mean ED length of stay was longer in admitted patients than in discharged patients (6.5 vs. 4.3 h).

CONCLUSIONS

Variation between local practice and SCHN guideline recommendations was identified in severity assessment, pharmacological management, imaging utilisation and discharge planning. Targeted quality improvement strategies, including implementation of ED short-stay models, structured electronic severity assessment tools and staff education initiatives, may support improved adherence to guideline-based care.