'Inadequate' A&E assessment of children
14 February 2004

Many children with asthma are being inadequately assessed by hospital A&E departments that fail to follow medical guidelines for asthma care, according to research published in the Emergency Medical Journal.

Children in the UK have one of the highest rates of asthma in the world, with one in eight kids having the condition. National guidance recommends that when people arrive in A&E with acute asthma symptoms, health professionals should measure heart rate, respiratory rate, the level of oxygen in the blood and, for those aged 5 or over, their peak flow, which measures lung function.

These tests allow doctors to assess how severe a patient's asthma is, and whether they should be admitted to hospital. They are considered a key factor in preventing deaths, giving appropriate treatment and reducing future risk.

Researchers from Guy's hospital set out to discover whether the guidelines were being applied in the assessment of children with asthma in emergency departments. They analysed the records of 225 children aged 3-14 years attending A&E with asthma symptoms in four London hospitals.

They found that only 42% of the over-5s had all four vital signs recorded, as recommended in asthma guidelines. Less than half of the children had their peak flow measured, which is considered by many paediatricians to be a useful indicator of whether hospital admission is needed.

'Our findings suggest that the A&E departments are assessing severity of asthma in children inadequately,' said the researchers. 'It is probable that many children are discharged inappropriately, leading to worse morbidity and reattendance, or admitted inappropriately leading to avoidable consumption of health care resources,' they concluded.

'High quality assessment of severity could help reduce this. Our study shows that the guidance is still not followed.'

'This is a very worrying report,' responded Martin Dockrell, the National Asthma Campaign's assistant director of information and policy. 'We already had a strong sense that asthma emergency in this country is often not up to scratch, and working with people with asthma and the NHS is one of our top priorities.'