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To evaluate the effect of initiating steroids at triage for children presenting to a pediatric emergency department with moderate to severe asthma exacerbations, investigators compared outcomes before and after introduction of a medical directive allowing triage nurses to administer steroids. Prior to the directive, physicians initiated steroids. Triage nurses administered inhaled β-agonists during both periods. Clinicians used the Pediatric Respiratory Assessment Measure (PRAM) to determine asthma severity; the PRAM is a validated 12-point clinical scoring system that discriminates severity based on five attributes: suprasternal retractions, scalene contractions, wheezing, air entry, and oxygen saturation.
Researchers reviewed charts of 644…