First Results of Assessing the Quality of Medical Care at Pre-Hospital and Hospital Stages for Children with Acute Allergic Pathology

Background. Differential diagnosis of exacerbations of allergic diseases in children at pre-hospital and hospital stages of rendering emergency medical care (EMC) remains a relevant issue. One of the reasons is that medical care does not always comply with current clinical guidelines.

Objective. Our aim was to analyze the quality of emergency medical care for children with acute allergic pathology.

Methods. A retrospective study with a retrospective analysis and extraction of data from medical records (in 2 stages) was conducted.

Results. The study analyzed the data of 595 children with acute allergic pathology who applied for emergency medical care (girls — 215; 36.13%). The average age of patients was 43.12 ± 41.09 months, 455 (76.47%) were under 5 years of age. 513 (86.22%) children applied for medical care for the first time, 24 (4.03%) children — for the second time; in 58 (9.75%) emergency team call records, this column was not filled. Based on the complaints and diagnoses indicated in the medical documentation, the children were divided into 3 groups: Croup, Cutaneous Manifestations of Allergy, and Bronchopulmonary Manifestations. We analyzed the reliability and validity of final diagnoses made at pre-hospital and hospital stages and assessed the adequacy of the carried out pharmacotherapy.

Conclusion. According to our study, the quality of medical care at pre-hospital and hospital stages does not always correspond to current standards, algorithms, and available clinical guidelines.

1. Sicherer SH, Simons FE; Section on Allergy and Immunology. Epinephrine for first-aid management of anaphylaxis. Pediatrics. 2017;139(3):e20164006. doi: 10.1542/peds.2016-4006.

2. Аллергология и иммунология. Клинические рекомендации для педиатров / Под общей ред. А.А. Баранова, Р.М. Хаитова. — М.; 2011. — 248 с. [Allergologiya i immunologiya. Klinicheskie rekomendatsii dlya pediatrov. Ed by A.A. Baranov, R.M. Khaitov. Moscow; 2011. 248 p. (In Russ).]

3. Cheng A. Emergency treatment of anaphylaxis in infants and children. Paediatr Child Health. 2011;16(1):35–40. doi: 10.1093/pch/16.1.35.

4. emedicine. medscape.com [Internet] Jeffrey F Linzer. Pediatric Anaphylaxis [cited 2017 Jun 5] Available from: https://emedicine.medscape.com/article/799744-overview.

5. eaaci.org [Internet] EAACI. Food Allergy & Anaphylaxis Public Declaration [cited 2017 Jun 19]. Available from: http://www.eaaci.org/452-resources/food-allergy-a-anaphylaxispublic-declaration-/2128-food-allergy-a-anaphylaxis-publicdeclaration.html.

6. Pite H, Wedi B, Borrego LM, et al. Management of childhood urticaria: current knowledge and practical recommendations. Acta Derm Venereol. 2013;93(5):500–508. doi: 10.2340/00015555-1573.

7. Turner PJ, Gowland MH, Sharma V, et al. Increase in anaphylaxisrelated hospitalizations but no increase in fatalities: an analysis of United Kingdom national anaphylaxis data, 1992-2012. J Allergy Clin Immunol. 2015;135(4):956–963.e951. doi: 10.1016/j.jaci.2014.10.021.

8. lung.org [Internet].American lung association. Asthma & Children Fact Sheet [cited 2017 May 17]. Available from: http://www.lung.org/lung-health-and-diseases/lung-disease-lookup/asthma/learnabout-asthma/asthma-children-facts-sheet.html.

9. Ismaila AS, Sayani AP, Marin M, Su Z. Clinical, economic, and humanistic burden of asthma in Canada: a systematic review. BMC Pulm Med. 2013;13:70. doi: 10.1186/1471-2466-13-70.

10. Ewan P, Brathwaite N, Leech S, et al. BSACI guideline: prescribing an adrenaline auto-injector. Clin Exp Allergy. 2016;46(10):1258–1280. doi: 10.1111/cea.12788.

11. Приказ Министерства здравоохранения Российской Федерации от 20 июня 2013 г. №388н «Об утверждении Порядка оказания скорой, в том числе скорой специализированной, медицинской помощи». [Order of the Ministry of Health of the Russian Federation dated June 20, 2013 №388n «Ob utverzhdenii Poryadka okazaniya skoroi, v tom chisle skoroi spetsializirovannoi, meditsinskoi pomoshchi». (In Russ).] Доступно по: https://www.rosminzdrav.ru/documents/9118-prikaz-ministerstvazdravoohraneniya-rossiyskoy-federatsii-ot-20-iyunya-2013-g-388nob-utverzhdenii-poryadka-okazaniya-skoroy-v-tom-chisle-skoroyspetsializirovannoy-meditsinskoy-pomoschi. Ссылка активна на 25.09.2017.

12. Стандарты скорой медицинской помощи. Министерство здравоохранения РФ. — M.; 2014. [Standarty skoroi meditsinskoi pomoshchi. Ministry of Health. Moscow; 2014. (In Russ).] Доступно по: https://www.rosminzdrav.ru/ministry/61/22/stranitsa-979/stranitsa-983. Ссылка активна на 22.09.2017.

13. Алгоритмы действий врача Службы скорой медицинской помощи Санкт-Петербурга. — СПб.; 2009. — 113 с. [Algoritmy deistvii vracha Sluzhby skoroi meditsinskoi pomoshchi SanktPeterburga. St. Petersburg; 2009. 113 p. (In Russ).]

14. Байбарина Е.Н., Баранов А.А., Намазова-Баранова Л.С., и др. Оценка качества стационарной помощи детям в регионах Российской Федерации // Вестник Российской академии медицинских наук. — 2016. — Т.71. — №3 — С. 214–223. [Baybarina EN, Baranov AA, Namazova-Baranova LS, et al. Pediatric health quality assessment in different regions of Russian Federation. Annals of the Russian academy of medical sciences. 2016;71(3):214–223. (In Russ).] doi: 10.15690/vramn688.

15. Вишнёва Е.А., Намазова-Баранова Л.С., Алексеева А.А., и др. Современные принципы терапии аллергического ринита у детей // Педиатрическая фармакология. — 2014. — Т.11. — №1 — С. 6–14. [Vishneva EA, Namazova-Baranova LS, Alexeyeva AA, et al. Modern principles of allergic rhinitis therapy in children. Pediatric pharmacology. 2014;11(1):6–14. (In Russ).] doi: 10.15690/pf.v11i1.889.

16. Селимзянова Л.Р., Вишнёва Е.А., Промыслова Е.А. Средства доставки лекарственных препаратов при ингаляционной терапии у детей: критерии выбора // Педиатрическая фармакология. — 2014. — Т.11. — №5 — С. 40–44. [Selimzyanova LR, Vishneva EA, Promyslova EA. Means of drug delivery in the event of inhalation therapy in children: selection criteria. Pediatric pharmacology. 2014;11(5):40–44. (In Russ).] doi: 10.15690/pf.v11i5.1163.

17. Лихорадочные синдромы у детей. Рекомендации по диагностике и лечению / Под ред. А.А. Баранова, В.К. Таточенко, М.Д. Бакрадзе. — М.; 2011. — 228 с. [Likhoradochnye sindromy u detei. Rekomendatsii po diagnostike i lecheniyu. Ed by A.A. Baranov, V.K. Tatochenko, M.D. Bakradze. Moscow; 2011. 228 p. (In Russ).]

18. Пушкарева А.С., Солонинина А.В. Ассортимент лекарственных препаратов, применяемых для купирования болевого синдрома // Современные проблемы науки и образования. — 2015. — №2–2 — С. 513. [Pushkareva AS, Soloninina AV. The assortment of drugs used for relief of pain. Sovremennye problemy nauki i obrazovaniya. 2015;(2–2):513. (In Russ).]

19. Таточенко В.К., Бакрадзе М.Д. Жаропонижающие средства // Педиатрическая фармакология. — 2011. — Т.8. — №5 — С. 83–86. [Tatochenko VK, Bakradze MD. Antipyretics. Pediatric pharmacology. 2011;8(5):83–86. (In Russ).]

20. Руководство по скорой медицинской помощи / Под ред. С.Ф. Багненко, А.Л. Верткина, А.Г. Мирошниченко, М.Ш. Хубутия. — М.: ГЭОТАР-Медиа; 2012. — 783 с. [Rukovodstvo po skoroi meditsinskoi pomoshchi. Ed by S.F. Bagnenko, A.L. Vertkin, A.G. Miroshnichenko, M.Sh. Khubutiya. Moscow: GEOTAR-Media; 2012. 783 p. (In Russ).]

21. Государственный реестр лекарственных средств. [Gosudarstvennyi reestr lekarstvennykh sredstv. (In Russ).] Доступно по: http://www.grls.rosminzdrav.ru/Grls_View_v2.aspx?routingGuid=fb9d5a3a-e12b-4487-8f96-84d216e31bf3&t=a4e12e2c-7a28-486b-ad2e-25d6e6628bf9. Ссылка активна на 20.09.2017.

22. Приказ Министерства здравоохранения Российской Федерации от 20 декабря 2012 г. №1281н «Об утверждении стандарта скорой медицинской помощи детям при стенозе гортани». [Order of the Ministry of Health of the Russian Federation dated December 20, 2012 №1281n «Ob utverzhdenii standarta skoroi meditsinskoi pomoshchi detyam pri stenoze gortani». (In Russ).] Доступно по: https://static-3.rosminzdrav.ru/system/attachments/attaches/000/025. Ссылка активна на 23.09.2017.

23. Al-Jahdali HH, Ai-Omar AM, Al-Moamary MS, et al. Implementation of the national asthma management guidelines in the emergency department. Saudi Med J. 2004;25(9):1208–1211.

24. Russell S, Monroe K, Losek JD. Anaphylaxis management in the pediatric emergency department: opportunities for improvement. Pediatr Emerg Care. 2010;26(2):71–76. doi: 10.1097/PEC.0b013e3181ce2e1c.

25. Arroabarren E, Lasa EM, Olaciregui I, Sarasqueta C, Munoz JA, Perez-Yarza EG. Improving anaphylaxis management in a pediatric emergency department. Pediatr Allergy Immunol. 2011; 22:708–714.

26. Hemler JA, Sharma HP. Management of children with anaphylaxis in an urban emergency department. Ann Allergy Asthma Immunol. 2017;118(3):381–383. doi: 10.1016/j.anai.2016.12.021.

27. Mostmans Y, Grosber M, Blykers M, et al. Adrenaline in anaphylaxis treatment and self-administration: experience from an inner city emergency department. Allergy. 2017;72(3):492–497. doi: 10.1111/all.13060.