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

Abstract

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.