A two part 8.5 month study was undertaken to see if peak expiratory flow rate (PEFR) could be used to guide casualty officers deciding whether to admit or discharge children with asthma. In part 1 PEFR, immediate treatment, and admission or discharge of all children attending because of asthma were recorded. In part 2 the same information was recorded after the introduction of admission and discharge guidelines based on PEFR. After the introduction of guidelines the proportion of children admitted with a PEFR > or = 40% expected after casualty treatment fell from 43% to 26% (part 1 44/101, part 2 38/145). For a PEFR > 60% the rate fell from 23% to 5% (part 1 12/52, part 2 4/80). There was no significant change in the reattendance rate. PEFR can help to reduce unnecessary admissions, provided appropriate normal values and guidelines are supplied.
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