응급실 소아 천식 환자를 위한 표준 진료 지침의 적용: 부정확 적용군과의 비교
Clinical Pathway for Childhood Asthma in an Emergency Department: Comparison Between the Correct Versus Incorrect Application Groups
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목적:응급실을 방문한 소아 천식 환자에게, 근거에 중심을 둔 표준 진료 지침을 적용하는 것이, 우리나라의 응급실에서 정확하게 시행될 수 있는지 알아보고 표준 진료 지침의 정확한 적용이 치료의 효과를 향상시키는지를 알아 보고자 하였다. 방법:2009년 1월 1일부터 2009년 12월 31일 까지 천식의 급성 악화를 주소로 응급실을 방문한 소아 환자 전원에게 표준 진료 지침을 적용하였다. 응급실 진료기록을 조사하여 표준 진료 지침이 정확하게 적용되었는지를 조사하였다. 또한 정확하게 적용된 집단과 부정확하게 적용된 집단으로 나누어 치료의 효과를 비교 하였다. 결과:연구 대상 51명의 급성 천식 악화 환아 중 표준 진료 지침이 정확하게 적용된 환자는 24명(47%)이었고, 부정확하게 적용된 환자는 27명(53%) 이었다. 부정확하게 적용된 군에서는 중등도 악화가 많았다. 부정확하게 적용된 내용으로는, 흡인성 항콜린제를 사용하지 않았거나 적게 시행한 경우가 가장 많았다. 잘못 적용된 이유로는 응급실에서 환자를 진료한 전공의의 숙지 미숙이 가장 많았다. 표준 진료 지침의 항목 중 핵심적인 치료를 부정확하게 실행한 환자에서 병실로의 입원율이 높았다. 결론:응급실을 방문한 소아 천식 환자에 대하여, 표준 진료 지침을 적용하는 것은 치료의 효과를 향상 시켰다. 그러나, 이 지침을 정확하게 적용하기 위하여는 중등도 악화 환자에 대한 집중 관리 및 응급실에서 진료를 하는 전공의에 대한 교육의 강화가 필요하다.
Abstract
Purpose:This study aimed to determine whether the standard clinical pathway based on evidence is applicable to pediatric asthma patients in the emergency room, and whether it is better for treatment effectiveness. Methods:The clinical pathway was applied to children who visited our emergency room due to acute asthma between January 1 and December 31, 2009. Medical records of the emergency room were reviewed to see if the clinical pathway was correctly applied. The patients were divided into 2 groups: those who the pathway was correctly applied and those who the pathway was incorrectly applied to (group B, n=41). Results:Acute asthma exacerbation occurred in 24 children (47%) in group A, while it occurred in 27 children (53%) in group B. The majority of patients in group B had moderate asthma exacerbation. The incorrect application of the clinical pathway and no use or insufficient use of inhaled anticholinergics was most frequently noted. The most common cause for the incorrect application of the clinical pathway was its misunderstanding of residents. The hospitalization rate was higher in group B than in group A. Conclusion:The application of the clinical pathway to pediatric asthma patients in the emergency room increased treatment effectiveness. However, training for the residents and intensive care for the patient with moderate asthma exacerbation are necessary for correct application of the clinical pathway.
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