Nurse vs physician decision-making in the ED for short acting β2-agonist administration in pediatric asthma.

OBJECTIVE

To evaluate triage nurses' clinical judgment in determining short acting β2-agonist bronchodilator therapy need for children with shortness of breath in the pediatric emergency department, without prior physician assessment.

METHODS

This prospective study compared decision-making between triage nurses and physicians regarding bronchodilator inhalation therapy necessity. Trained nurses assessed children aged 2-18 with shortness of breath, including history-taking, vital signs, and lung auscultation. Nurses made short acting β2-agonist therapy decisions based on predefined criteria. Pediatric specialists independently evaluated patients and recorded their decision.

RESULTS

Analysis of 62 assessments from 31 patients showed no statistically significant difference between nurses and doctors in administering inhaled bronchodilators (nurses: 87.1 %, doctors: 83.9 %). Clinical sign detection was similar, except for tachypnea (nurses: 48.4 %, doctors: 71 %, P = 0.07). McNemar's test and Cohen's kappa coefficient demonstrated strong nurse-doctor correlation per patient (accuracy: 83.9 %, P = 0.1; kappa: 0.351).

CONCLUSIONS

Nurses excelled in recognizing certain clinical signs but showed lower compatibility in others. For severe cases, nurses consistently identified patients needing additional treatments.