Pediatric respiratory distress: California out-of-hospital protocols and evidence-based recommendations

Tabitha Cheng; Jennifer Farah; Nicholas Aldridge; Sharon Tamir; J Joelle Donofrio-Odmann

doi:10.1002/emp2.12103

Pediatric respiratory distress: California out-of-hospital protocols and evidence-based recommendations

J Am Coll Emerg Physicians Open. 2020 Jun 8;1(5):955-964. doi: 10.1002/emp2.12103. eCollection 2020 Oct.

Authors

Tabitha Cheng¹, Jennifer Farah¹, Nicholas Aldridge¹, Sharon Tamir^{2

3}, J Joelle Donofrio-Odmann^{1

2

3}

Affiliations

¹ Department of Emergency Medicine University of California San Diego (UCSD) San Diego California USA.
² Department of Pediatrics UCSD San Diego California USA.
³ Rady Children's Hospital of San Diego San Diego California USA.

Abstract

Objectives: Prehospital protocols vary across local emergency medical service (EMS) agencies in California. We sought to develop evidence-based recommendations for the out-of-hospital evaluation and treatment of pediatric respiratory distress, and we evaluated the protocols for pediatric respiratory distress used by the 33 California local EMS agencies.

Methods: Evidence-based recommendations were developed through an extensive literature review of the current evidence regarding out-of-hospital treatment of pediatric patients with respiratory distress. The authors compared the pediatric respiratory distress protocols of each of the 33 California local EMS agencies with the evidence-based recommendations. Our focus was on the treatment of 3 main pediatric respiratory complaints by presentation: stridor (croup), wheezing < 24 months (bronchiolitis), and wheezing > 24 months (asthma).

Results: Protocols across the 33 California local EMS agencies varied widely. Stridor (croup) had the highest protocol variability of the 3 presentations we evaluated, with no treatment having uniform use among all agencies. Only 3 (9.1%) of the local EMS agencies differentiated wheezing in children < 24 months of age, referencing this as possible bronchiolitis. All local EMS agencies included albuterol and epinephrine (intravenous/intramuscular) in their pediatric wheezing (asthma) treatment protocols. The least common treatments for wheezing (asthma) included nebulized epinephrine (3/33) and magnesium (2/33). No agencies included steroids in their treatment protocols (0/33).

Conclusion: Protocols for pediatric respiratory distress vary widely across the state of California, especially among those for stridor (croup) and wheezing in < 24 months (bronchiolitis). The evidence-based recommendations that we present for the prehospital treatment of these conditions may be useful for EMS medical directors tasked with creating and revising these protocols.

Keywords: California; Respiratory distress; emergency medical services; evidence‐based; pediatric; prehospital; protocols; stridor; wheezing.