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Meta-Analysis
. 2009 Apr 15;2009(2):CD001290.
doi: 10.1002/14651858.CD001290.pub2.

Interventions for educating children who are at risk of asthma-related emergency department attendance

Michelle Boyd  1 , Toby J Lasserson, Michael C McKean, Peter G Gibson, Francine M Ducharme, Michelle Haby
Affiliations
Meta-Analysis

Interventions for educating children who are at risk of asthma-related emergency department attendance

Michelle Boyd et al. Cochrane Database Syst Rev. .

Abstract

Background: Asthma is the most common chronic childhood illness and is a leading cause for paediatric admission to hospital. Asthma management for children results in substantial costs. There is evidence to suggest that hospital admissions could be reduced with effective education for parents and children about asthma and its management.

Objectives: To conduct a systematic review of the literature and update the previous review as to whether asthma education leads to improved health outcomes in children who have attended the emergency room for asthma.

Search strategy: We searched the Cochrane Airways Group Trials Register, including the MEDLINE, EMBASE and CINAHL databases, and reference lists of trials and review articles (last search May 2008).

Selection criteria: We included randomised controlled trials of asthma education for children who had attended the emergency department for asthma, with or without hospitalisation, within the previous 12 months.

Data collection and analysis: Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information. We pooled dichotomous data with a fixed-effect risk ratio. We used a random-effects risk ratio for sensitivity analysis of heterogenous data.

Main results: A total of 38 studies involving 7843 children were included. Following educational intervention delivered to children, their parents or both, there was a significantly reduced risk of subsequent emergency department visits (RR 0.73, 95% CI 0.65 to 0.81, N = 3008) and hospital admissions (RR 0.79, 95% CI 0.69 to 0.92, N = 4019) compared with control. There were also fewer unscheduled doctor visits (RR 0.68, 95% CI 0.57 to 0.81, N = 1009). Very few data were available for other outcomes (FEV1, PEF, rescue medication use, quality of life or symptoms) and there was no statistically significant difference between education and control.

Authors' conclusions: Asthma education aimed at children and their carers who present to the emergency department for acute exacerbations can result in lower risk of future emergency department presentation and hospital admission. There remains uncertainty as to the long-term effect of education on other markers of asthma morbidity such as quality of life, symptoms and lung function. It remains unclear as to what type, duration and intensity of educational packages are the most effective in reducing acute care utilisation.

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Conflict of interest statement

None known.

Figures

1
1
Flow diagram of literature search for 2008 update.
2
2
Methodological quality summary: review authors' judgements about each methodological quality item for each included study.
3
3
Forest plot of comparison: 1 Education (any type) versus control, outcome: 1.1 ED visits (% subjects).
4
4
Funnel plot of comparison: 1 Education (any type) versus control, outcome: 1.1 ED visits (% subjects).
1.1
1.1. Analysis
Comparison 1 Education (any type) versus control, Outcome 1 ED visits (% subjects).
1.2
1.2. Analysis
Comparison 1 Education (any type) versus control, Outcome 2 Hospital admissions (% subjects).
1.3
1.3. Analysis
Comparison 1 Education (any type) versus control, Outcome 3 Unscheduled doctor visits (% subjects).
1.4
1.4. Analysis
Comparison 1 Education (any type) versus control, Outcome 4 Withdrawal.
1.5
1.5. Analysis
Comparison 1 Education (any type) versus control, Outcome 5 Mortality.
1.6
1.6. Analysis
Comparison 1 Education (any type) versus control, Outcome 6 FEV1 predicted.
1.7
1.7. Analysis
Comparison 1 Education (any type) versus control, Outcome 7 PEF.
1.8
1.8. Analysis
Comparison 1 Education (any type) versus control, Outcome 8 Rescue medication use (puffs/d).
1.9
1.9. Analysis
Comparison 1 Education (any type) versus control, Outcome 9 Quality of life (AQLQ).
1.10
1.10. Analysis
Comparison 1 Education (any type) versus control, Outcome 10 Symptoms.
2.1
2.1. Analysis
Comparison 2 Education (any type) versus control; subdivided by age of subjects, Outcome 1 ED visits (% subjects).
2.2
2.2. Analysis
Comparison 2 Education (any type) versus control; subdivided by age of subjects, Outcome 2 Hospital admissions (% subjects).
2.3
2.3. Analysis
Comparison 2 Education (any type) versus control; subdivided by age of subjects, Outcome 3 Unscheduled doctor visits (% subjects).
3.1
3.1. Analysis
Comparison 3 Education (any type) versus control; subdivided by 'net intervention', Outcome 1 ED visits (% subjects).
3.2
3.2. Analysis
Comparison 3 Education (any type) versus control; subdivided by 'net intervention', Outcome 2 Hospital admissions (% subjects).
3.3
3.3. Analysis
Comparison 3 Education (any type) versus control; subdivided by 'net intervention', Outcome 3 Unscheduled doctor visits (% subjects).
4.1
4.1. Analysis
Comparison 4 Education (any type) versus control; subdivided by who delivered intervention, Outcome 1 ED visits (% subjects).
4.2
4.2. Analysis
Comparison 4 Education (any type) versus control; subdivided by who delivered intervention, Outcome 2 Hospital Admissions (% subjects).
4.3
4.3. Analysis
Comparison 4 Education (any type) versus control; subdivided by who delivered intervention, Outcome 3 Unscheduled doctor visits (% subjects).
5.1
5.1. Analysis
Comparison 5 Education (any type) versus control; subdivided by timing of intervention, Outcome 1 ED visits (% subjects).
5.2
5.2. Analysis
Comparison 5 Education (any type) versus control; subdivided by timing of intervention, Outcome 2 Hospital admissions (% subjects).
5.3
5.3. Analysis
Comparison 5 Education (any type) versus control; subdivided by timing of intervention, Outcome 3 Unscheduled doctor visits (% subjects).
6.1
6.1. Analysis
Comparison 6 Education (any type) versus control; subdivided by intensity of control intervention, Outcome 1 ED visits (% subjects).
6.2
6.2. Analysis
Comparison 6 Education (any type) versus control; subdivided by intensity of control intervention, Outcome 2 Hospital admissions (% subjects).
6.3
6.3. Analysis
Comparison 6 Education (any type) versus control; subdivided by intensity of control intervention, Outcome 3 Unscheduled doctor visits (% subjects).
7.1
7.1. Analysis
Comparison 7 Education (any type) versus control; subdivided by timing of outcome assessment, Outcome 1 ED visits (% subjects).
7.2
7.2. Analysis
Comparison 7 Education (any type) versus control; subdivided by timing of outcome assessment, Outcome 2 Hospital admissions (% subjects).
7.3
7.3. Analysis
Comparison 7 Education (any type) versus control; subdivided by timing of outcome assessment, Outcome 3 Unscheduled doctor visits (%subjects).
8.1
8.1. Analysis
Comparison 8 Sensitivity analysis by risk of bias, Outcome 1 ED visits (allocation bias).
8.2
8.2. Analysis
Comparison 8 Sensitivity analysis by risk of bias, Outcome 2 ED visits (completeness of follow up).
See this image and copyright information in PMC

Update of

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References to studies included in this review

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References to ongoing studies

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References to other published versions of this review

Haby 2001
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MeSH terms