Nurse-Led treatment strategy based on asthma score and oxygen requirement in children with acute reversible bronchoconstriction: A randomised controlled non-inferiority trial

OBJECTIVE: The Childhood Asthma Score (CAS) does not fully account for oxygen therapy in children with acute reversible bronchoconstriction (ARB), thus the CAS O2 was developed. Our aim was to assess effectiveness and safety of the CAS O2 treatment protocol compared to the CAS protocol. DESIGN: Multicentre, open-label, randomised, non-inferiority trial. SETTING: Two Dutch teaching hospitals with general paediatric wards. PATIENTS: Children 2-18 years admitted with ARB, requiring supplemental oxygen. INTERVENTIONS: Nurse led treatment strategies using CAS O2 (tailored for patients receiving supplemental oxygen) or CAS to guide bronchodilator administration and reassessment intervals. MAIN OUTCOME MEASURE: Length of hospital stay (LOS); non-inferiority margin of 8 hours. RESULTS: Data of 132 children who required supplemental oxygen were analysed (CAS O2 group n = 69; CAS n = 63). Median LOS was 40.0 hours (IQR 25.5-47.0) with CAS O2 and 40.8 hours (IQR 27.1-65.2) with CAS. The adjusted absolute difference in LOS (CAS O2 - CAS) was -3.7 hours (95% CI -10.2 to 4.1), meeting non inferiority. Bronchodilator administrations were fewer with CAS O2 (mean 7.9 versus 10.5; rate ratio 0.75, (95% CI 0.64-0.88; p < 0.001). Safety outcomes (physician assessments, intravenous magnesium sulphate or salbutamol, PICU transfer, 7 day readmission) did not differ between groups. CONCLUSIONS: Compared with CAS, CAS O2 supports nurse-led management of children hospitalised with ARB, including those requiring supplemental oxygen, with fewer bronchodilator administrations and no prolongation of LOS. These findings support broader implementation of CAS O2 -based pathways.