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Pediatric Wheeze/Bronchospasm

Date Last Search Run: Feb 01, 2022
Table last updated: Apr 02, 2022
Data last added: Mar 19, 2022

Recommendation RECOMMENDATION FOR INTERVENTION
STRENGTH OF EVIDENCE FOR INTERVENTION   SUPPORTIVE (Green) NEUTRAL (Yellow) AGAINST (Red) NOT YET GRADED (White)
1 (strong evidence exists)    
2 (fair evidence exists)  
3 (weak evidence exists)  


Interventions

Anticholinergic
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Functional neurologic outcome Patient ED-MD Browne GJ., Trieu L., Van Asperen P. Randomized, double-blind, placebo-controlled trial of intravenous salbutamol and nebulized ipratropium bromide in early management of severe acute asthma in children presenting to an emergency department. Crit Care Med 2002; 30(2):448-53. Medline
I Supportive (Green) Asthma Severity Score, PEFR Process ED-MD Calvo GM., Calvo AM., Marin HF., et al. Is it useful to add an anticholinergic treatment to beta 2-adrenergic medication in acute asthma attack? J Investig Allergol Clin Immunol 1998; 8:30-4. Medline
I Supportive (Green) FEV1 Patient ED-MD Osmond MH., Klassen TP.. Efficacy of ipratropium bromide in acute childhood asthma: A meta-analysis. Acad Emerg Med 1995; 2:651-6. Medline
I Supportive (Green) Rate of hospitalization Patient ED-MD Qureshi F., Pestian J., Davis P., et al. Effect of nebulized ipratropium on the hospitalization rates of children with asthma. N Engl J Med 1998; 339(15):1030-5. Medline
I Supportive (Green) PEFR Patient ED-MD Qureshi F., Zaritsky A., Lakkis H. Efficacy of nebulized ipratropium in severely asthmatic children. Ann Emerg Med 1997; 29:205-11. Medline
I Supportive (Green) Time to discharge Patient ED-MD Zorc JJ., Pusic MV., Ogborn CJ., et al. Ipratropium bromide added to asthma treatment in the pediatric emergency department. Pediatrics 1999; 103:748-52. Medline
I Neutral (Yellow) Improvement in respiratory resistance Process ED-MD Ducharme FM., Davis GM. Randomized controlled trial of ipratropium bromide and frequent low doses of salbutamol in the management of mild and moderate acute pediatric asthma. J Pediatr 1998; 133:479-85. Medline
I Neutral (Yellow) Difference in median asthma score at 2 hours Patient ED-MD Upham BD., Mollen CJ., Scarfone RJ., Seiden J., Chew A., Zorc JJ. Nebulized budesonide added to standard pediatric emergency department treatment of acute asthma: a randomized, double-blind trial. Acad Emerg Med 2011; 18(7):665-673. Medline
I Neutral (Yellow) Admission to hospital Patient ED-MD Wyatt EL., Borland ML., Doyle SK., Geelhoed GC. Metered-dose inhaler ipratropium bromide in moderate acute asthma in children: A single-blinded randomised controlled trial. J Paediatr Child Health 2015; 51(2):192-198. Medline

Beta Agonist-MDI
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Time to conversion Process ED-MD Avila-Castanon L., Casas-Becerra B., Del Rio-Navarro BE., Velazquez-Armenta Y., Sienra-Monge JJ. Formoterol vs. albuterol administered via Turbuhaler system in the emergency treatment of acute asthma in children. Allergol Immunopathol (Madr) 2004; 32(1):18-20. Medline
I Supportive (Green) Asthma Severity Score Patient ED-MD Chou KJ., Cunningham SJ., Crain EF. Metered-dose inhalers with spacers vs nebulizers for pediatric asthma. Arch Pediatr Adolesc Med 1995; 149(2):201-5. Medline
I Supportive (Green) Cardioversion rates Patient ED-MD Rodrigo GJ., Neffen H., Colodenco FD., Castro-Rodriguez JA. Formoterol for acute asthma in the emergency department: a systematic review with meta-analysis. Ann Allergy Asthma Immunol 2010; 104(3):247-52. Medline
I Supportive (Green) Respiratory rate 60 minutes post intervention Patient ED-MD Williams JR., Bothner JP., Swanton RD. Delivery of albuterol in a pediatric emergency department. Pediatr Emerg Care 1996; 12:263-7. Medline
II Supportive (Green) Correction of bronchoconstriction Patient ED-MD Quezada A., Mallol J., Moreno J., et al. Effect of different inhaled bronchodilators on recovery from methacholine-induced bronchoconstriction in asthmatic children. Pediatr Pulmonol 1999; 28:125-9. Medline

Beta Agonist-Nebulized
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Treatment failure Patient Other Baggott C, Hardy JK, Sparks J, Sabbagh D, Beasley R, Weatherall M, et al. Epinephrine (adrenaline) compared to selective beta-2-agonist in adults or children with acute asthma: a systematic review and meta-analysis. Thorax 2021. Medline
I Supportive (Green) Efficacy and safety Process ED-MD Becker AB., Nelson NA., Simons FE. Inhaled salbutamol (albuterol) vs injected epinephrine in the treatment of acute asthma in children. J Pediat 1983; 102:465-9. Medline
I Supportive (Green) Asthma Severity Score, PEFR Process ED-MD Calvo GM., Calvo AM., Marin HF., et al. Is it useful to add an anticholinergic treatment to beta 2-adrenergic medication in acute asthma attack? J Investig Allergol Clin Immunol 1998; 8:30-4. Medline
I Supportive (Green) Asthma Severity Score Patient ED-MD Chou KJ., Cunningham SJ., Crain EF. Metered-dose inhalers with spacers vs nebulizers for pediatric asthma. Arch Pediatr Adolesc Med 1995; 149(2):201-5. Medline
I Supportive (Green) Peak flow Process ED-MD Gutglass DJ., Hampers L., Roosevelt G., Teoh D., Nimmagadda SR., Krug SE. Undiluted albuterol aerosols in the pediatric emergency department. Pediatrics 2000; 105(5):E67. Medline
I Supportive (Green) Respiratory Distress Assessment Instrument Patient ED-MD Mull CC., Scarfone RJ., Ferri LR., et al. A randomized trial of nebulized epinephrine vs albuterol in the emergency department treatment of bronchiolitis. Arch Pediatr Adolesc Med 2004; 158(2):113-8. Medline
I Supportive (Green) Spirometric measures Patient ED-MD Rodrigo GJ., Neffen H., Colodenco FD., Castro-Rodriguez JA. Formoterol for acute asthma in the emergency department: a systematic review with meta-analysis. Ann Allergy Asthma Immunol 2010; 104(3):247-52. Medline
I Supportive (Green) Difference in median asthma score at 2 hours Patient ED-MD Upham BD., Mollen CJ., Scarfone RJ., Seiden J., Chew A., Zorc JJ. Nebulized budesonide added to standard pediatric emergency department treatment of acute asthma: a randomized, double-blind trial. Acad Emerg Med 2011; 18(7):665-673. Medline
I Supportive (Green) ED discharge after single treatment Patient ED-MD Walsh P., Caldwell J., McQuillan KK., Friese S., Robbins D., Rothenberg SJ. Comparison of nebulized epinephrine to albuterol in bronchiolitis. Acad Emerg Med 2008; 15(4):305-313. Medline
I Supportive (Green) FEV1 Process ED-MD Wilkinson M., Bulloch B., Garcia-Filion P., Keahey L. Efficacy of racemic albuterol versus levalbuterol used as a continuous nebulization for the treatment of acute asthma exacerbations: A randomized, double-blind, clinical trial. J Asthma 2011; 48(2):188-193. Medline
I Supportive (Green) PEFR Process ED-MD Williams JR., Bothner JP., Swanton RD. Delivery of albuterol in a pediatric emergency department. Pediatr Emerg Care 1996; 12:263-7. Medline
I Neutral (Yellow) Hospitalization rate Process ED-MD Carl JC., Myers TR., Kirchner HL., Kercsmar CM. Comparison of racemic albuterol and levalbuterol for treatment of acute asthma. J Pediatr 2003; 143(6):731-6. Medline

Beta Agonist-Parenteral
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Time to q2h nebulizers, Duration of oxygen therapy, Length of stay Process ED-MD Browne GJ., Trieu L., Van Asperen P. Randomized, double-blind, placebo-controlled trial of intravenous salbutamol and nebulized ipratropium bromide in early management of severe acute asthma in children presenting to an emergency department. Crit Care Med 2002; 30(2):448-53. Medline
III Supportive (Green) Vital Signs Process ED-MD Bohn D., Kalloghlian A., Jenkins J., et al. Intravenous salbutamol in the treatment of status asthmaticus in children. Crit Care Med 1984; 12:892-6. Medline

Epinephrine-Nebulized
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Change in respiratory distress Patient ED-MD Grewal S., Ali S., McConnell DW., Vandermeer B., Klassen TP. A randomized trial of nebulized 3% hypertonic saline with epinephrine in the treatment of acute bronchiolitis in the emergency department. Arch Pediatr Adolesc Med 2009; 163(11):1007-12. Medline
I Supportive (Green) Respiratory Distress Assessment Instrument Patient ED-MD Mull CC., Scarfone RJ., Ferri LR., et al. A randomized trial of nebulized epinephrine vs albuterol in the emergency department treatment of bronchiolitis. Arch Pediatr Adolesc Med 2004; 158(2):113-8. Medline
I Supportive (Green) Pulmonary index score Patient ED-MD Plint A., Osmond M., Klassen T. The efficacy of nebulized racemic epinephrine in children with acute asthma: A randomized, double-blind trial. Academy Emerg Med 2000; 7:1097-103. Medline
I Supportive (Green) Futility Patient PH-Paramedic Walsh P., Caldwell J., McQuillan KK., Friese S., Robbins D., Rothenberg SJ. Comparison of nebulized epinephrine to albuterol in bronchiolitis. Acad Emerg Med 2008; 15(4):305-313. Medline
I Neutral (Yellow) Hospital admission Process ED-MD Hariprakash S., Alexander J., Carroll W., et al. Randomized controlled trial of nebulized adrenaline in acute bronchiolitis. Pediatr Allergy Immunol 2003; 14(2):134-9. Medline
I Neutral (Yellow) Improvement in mean respiratory rate, mean oxygen saturation value and severity score Patient ED-MD Simsek-Kiper PO., Kiper N., Hascelik G., et al. Emergency room management of acute bronchiolitis: A randomized trial of nebulized epinephrine. Turk J Pediatr.\ 2011; 53(6):651-660. Medline
III Supportive (Green) DC from ED Process ED-MD Ledwith CA., Shea LM., Mauro RD. Safety and efficacy of nebulized racemic epinephrine in conjunction with oral dexamethasone and mist in the outpatient treatment of croup. Ann Emerg Med 1995; 25(3):331-337. Medline

Epinephrine-Parenteral
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Treatment failure Patient Baggott C, Hardy JK, Sparks J, Sabbagh D, Beasley R, Weatherall M, et al. Epinephrine (adrenaline) compared to selective beta-2-agonist in adults or children with acute asthma: a systematic review and meta-analysis. Thorax 2021. Medline
I Supportive (Green) Efficacy and safety Process ED-MD Becker AB., Nelson NA., Simons FE. Inhaled salbutamol (albuterol) vs injected epinephrine in the treatment of acute asthma in children. J Pediat 1983; 102:465-9. Medline

ETCO2
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Feasibility Process ED-MD Guthrie BD., Adler MD., Powell EC. ETCO2 measurements in children with acute asthma. Acad Emerg Med 2007; 14:1135-40. Medline

High flow nasal canula
Level Direction Primary Outcome Patient/Process Setting Reference
II Supportive (Green) Efficacy and safety Patient Vitaliti G., Vitaliti MC., Finocchiaro MC., Di SV., Pavone P., Matin N., et al. Randomized Comparison of Helmet CPAP Versus High-Flow Nasal Cannula Oxygen in Pediatric Respiratory Distress. Respir Care 2017; 62(8):1036-1042. Medline
II Neutral (Yellow) Safety, clinical effects and tolerance in children beyond the newborn period Patient Mikalsen IB., Davis P., Oymar K. High flow nasal cannula in children: a literature review. Scand J Trauma Resusc Emerg Med 2016; 24:93-016-0278-4. Medline
III Supportive (Green) Decrease in pulmonary score =2 Patient ED-MD Ballestero Y., De Pedro J., Portillo N., Martinez-Mugica O., Arana-Arri E., Benito J. Pilot Clinical Trial of High-Flow Oxygen Therapy in Children with Asthma in the Emergency Service. J Pediatr 2018; 194:204-10.e3. Medline
III Neutral (Yellow) Work of breathing Patient ED-MD Davison M, Watson M, Wockner L, Kinnear F. Paediatric high-flow nasal cannula therapy in children with bronchiolitis: A retrospective safety and efficacy study in a non-tertiary environment. Emergency medicine Australasia: EMA 2017; 29(2):198-203. Medline

Hypertonic Saline-Nebulized
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Bronchiolitis severity score Patient ED-MD Al-Ansari K., Sakran M., Davidson BL., El Sayyed R., Mahjoub H., Ibrahim K. Nebulized 5% or 3% hypertonic or 0.9% saline for treating acute bronchiolitis in infants. J Pediatr 2010; 157(4):630-4. Medline
I Supportive (Green) Hospital admission Patient ED-MD Wu S., Baker C., Lang ME., et al. Nebulized hypertonic saline for bronchiolitis: A randomized clinical trial. JAMA Pediatr 2014; 168(7):657-63. Medline
I Neutral (Yellow) Hospital admission up to 24 hours after enrollment in the study Process Angoulvant F, Bellĕttre X, Milcent K, Teglas JP, Claudet I, Le GC, et al. Effect of Nebulized Hypertonic Saline Treatment in Emergency Departments on the Hospitalization Rate for Acute Bronchiolitis: A Randomized Clinical Trial. JAMA pediatrics 2017; 171(8):e171333. Medline
I Neutral (Yellow) Respiratory scoring Patient ED-MD Florin TA., Shaw KN., Kittick M., Yakscoe S., Zorc JJ. Nebulized hypertonic saline for bronchiolitis in the emergency department: A randomized clinical trial. JAMA Pediatr 2014; 168(7):664-70. Medline

Ketamine
Level Direction Primary Outcome Patient/Process Setting Reference
III Supportive (Green) Reduction in respiratory distress Patient ED-MD Elkoundi A., Bentalha A., El Koraichi A., El Kettani SE. Nebulized ketamine to avoid mechanical ventilation in a pediatric patient with severe asthma exacerbation. Am J Emerg Med 2018; 36(4):734.e3-4. Medline

Magnesium Sulfate-IV
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Efficacy Patient Su Z., Li R., Gai Z. Intravenous and Nebulized Magnesium Sulfate for Treating Acute Asthma in Children A Systematic Review and Meta-Analysis. Pediatric Emergency Care 2016; 00:00. Medline
I Neutral (Yellow) Odds of admission to hospital Process Griffiths B., Kew KM., Normansell R. Intravenous magnesium sulfate for treating children with acute asthma in the emergency department. Paediatr Respir Rev 2016; 20:45-7. Medline
I Neutral (Yellow) Admission to hospital Process ED-MD Rowe B., Bretzlaff J., Bourdon C., et al. Intravenous magnesium sulfate treatment for acute asthma in the emergency department: A systematic review of the literature. Ann Emerg Med 2000; 36:181-90. Medline
I Neutral (Yellow) Pulmonary Index Score Patient ED-MD Scarfone RJ., Loiselle JM., Joffe MD., Mull CC., Stiller S., Thompson K., et al. A randomized trial of magnesium in the emergency department treatment of children with asthma. Ann Emerg Med 2000; 36(6):572-8. Medline
X Not Yet Graded (White) - DeLaroch AM, Mowbray FI, Bohsaghcheghazel M, Zalewski K, Obudzinski K. Early versus delayed administration of intravenous magnesium sulfate for pediatric asthma. Am J Emerg Med 2021; 50:36–40. Medline
X Not Yet Graded (White) - Irazuzta JE., Paredes F., Pavlicich V., Dominguez SL. High-Dose Magnesium Sulfate Infusion for Severe Asthma in the Emergency Department: Efficacy Study. Pediatr Crit Care Med 2016; 17(2):e29-33. Medline

Magnesium Sulfate-nebulized
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) Efficacy Patient Su Z., Li R., Gai Z. Intravenous and Nebulized Magnesium Sulfate for Treating Acute Asthma in Children A Systematic Review and Meta-Analysis. Pediatric Emergency Care 2016; 00:00. Medline
III Neutral (Yellow) MPIS Patient Turker S., Dogru M., Yildiz F., Yilmaz SB. The effect of nebulised magnesium sulphate in the management of childhood moderate asthma exacerbations as adjuvant treatment. Allergol Immunopathol (Madr) 2017; 45(2):115-120. Medline

NiPPV
Level Direction Primary Outcome Patient/Process Setting Reference
III Neutral (Yellow) Stabilization time Process Millán N, Alejandre C, Martinez-Planas A, Caritg J, Esteban E, Pons-Ã’dena M. Noninvasive Respiratory Support During Pediatric Ground Transport: Implementation of a Safe and Feasible Procedure. Respir Care 2017; 62(5):558-65. Medline

Oxygen-Humidified
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Bronchiolitis severity score Patient ED-MD Al-Ansari K., Sakran M., Davidson BL., El Sayyed R., Mahjoub H., Ibrahim K. Nebulized 5% or 3% hypertonic or 0.9% saline for treating acute bronchiolitis in infants. J Pediatr 2010; 157(4):630-4. Medline
I Neutral (Yellow) Hospital Admission Process ED-MD Hariprakash S., Alexander J., Carroll W., et al. Randomized controlled trial of nebulized adrenaline in acute bronchiolitis. Pediatr Allergy Immunol 2003; 14(2):134-9. Medline
III Neutral (Yellow) Feasibility Process Long E., Babl FE., Duke T. Is there a role for humidified heated high-flow nasal cannula therapy in paediatric emergency departments? Emerg Med J 2016; 33(6):386-9. Medline

Oxymetry Monitoring
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Hospitalization within 72 hours Patient ED-MD Schuh S., Freedman S., Coates A., et al. Effect of oximetry on hospitalization in bronchiolitis: A randomized clinical trial. JAMA 2014; 312(7):712-8. Medline

PEEP
Level Direction Primary Outcome Patient/Process Setting Reference
I Neutral (Yellow) Pulmonary Asthma Score Patient Navanandan N, Federico M, Mistry RD. Positive Expiratory Pressure for the Treatment of Acute Asthma Exacerbations: A Randomized Controlled Trial. J Pediatr 2017185:149-54.e2. Medline

Steroids-Inhaled
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Mortality Patient ED-MD Edmonds ML., Camargo CA. Jr, Pollack CV. Jr, Rowe BH. Early use of inhaled corticosteroids in the emergency department treatment of acute asthma. Cochrane Database Syst Rev 2003; 3(3):CD002308. Medline
I Neutral (Yellow) Hospital admission Process ED-MD Edmonds ML., Camargo CA. Jr, Pollack CV. Jr, Rowe BH. The effectiveness of inhaled corticosteroids in the emergency department treatment of acute asthma: a meta-analysis. Ann Emerg Med 2002; 40(2):145-54. Medline
I Neutral (Yellow) Difference in median asthma score at 2 hours Patient ED-MD Upham BD., Mollen CJ., Scarfone RJ., Seiden J., Chew A., Zorc JJ. Nebulized budesonide added to standard pediatric emergency department treatment of acute asthma: a randomized, double-blind trial. Acad Emerg Med 2011; 18(7):665-673. Medline

Steroids-Oral
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Hospital admission Process ED-MD Edmonds ML., Camargo CA. Jr, Pollack CV. Jr, Rowe BH. The effectiveness of inhaled corticosteroids in the emergency department treatment of acute asthma: a meta-analysis. Ann Emerg Med 2002; 40(2):145-54. Medline
I Supportive (Green) Pulmonary function Patient ED-MD Rowe BH., Kell JL., Oxman AD. Effectiveness of steroid therapy in acute exacerbations of asthma: A meta-analysis. Am J Emerg Med 1992; 10:301-10. Medline
I Supportive (Green) Hospital Admission Rate Process ED-MD Rowe BH., Spooner C., Ducharme FM., Bretzlaff JA., Bota GW. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev 2001; 1(1):CD002178. Medline
I Neutral (Yellow) Day until baseline Patient ED-MD Altamimi S., Robertson G., Jastaniah W., Davey A., Dehghani N., Chen R., et al. Single-dose oral dexamethasone in the emergency management of children with exacerbations of mild to moderate asthma. Pediatr Emerg Care 2006; 22(12):786-93. Medline
I Neutral (Yellow) time to transition from IV to oral diuretics Process ED-MD Corneli HM., Zorc JJ., Mahajan P., et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med 2007; 57(4):331-9. Medline
I Neutral (Yellow) Relapse within 10 days Process ED-MD Greenberg RA., Kerby G., Roosevelt GE. A comparison of oral dexamethasone with oral prednisone in pediatric asthma exacerbations treated in the emergency department. Clin Pediatr (Phila) 2008; 47(8):817-23. Medline
I Neutral (Yellow) Hospital Admission Patient ED-MD Scarfone RJ., Fuchs SM., Nager AL., Shane SA. Controlled trial of oral prednisone in the emergency department treatment of children with acute asthma. Pediatrics 1993; 92(4):513-8. Medline
II Supportive (Green) Time to clinical improvement, time to discharge, admission rate Patient ED-MD Zemek R., Plint A., Osmond MH., Kovesi T., Correll R., Perri N., et al. Triage nurse initiation of corticosteroids in pediatric asthma is associated with improved emergency department efficiency. Pediatrics 2012; 129(4):671-680. Medline
III Supportive (Green) DC from ED Process ED-MD Ledwith CA., Shea LM., Mauro RD. Safety and efficacy of nebulized racemic epinephrine in conjunction with oral dexamethasone and mist in the outpatient treatment of croup. Ann Emerg Med 1995; 25(3):331-337. Medline

Steroids-Parenteral
Level Direction Primary Outcome Patient/Process Setting Reference
I Supportive (Green) Hospital admission Process ED-MD Edmonds ML., Camargo CA. Jr, Pollack CV. Jr, Rowe BH. The effectiveness of inhaled corticosteroids in the emergency department treatment of acute asthma: a meta-analysis. Ann Emerg Med 2002; 40(2):145-54. Medline
I Supportive (Green) Pulmonary function Patient ED-MD Rowe BH., Kell JL., Oxman AD. Effectiveness of steroid therapy in acute exacerbations of asthma: A meta-analysis. Am J Emerg Med 1992; 10:301-10. Medline
I Supportive (Green) Hospital admission Patient ED-MD Tal A., Levy N., Bearman JE. Methylprednisolone therapy for acute asthma in infants and toddlers: A controlled clinical trial. Pediatrics 1990; 86:350-6. Medline
I Neutral (Yellow) Hospital admission Patient ED-MD Wolfson DH., Nypaver MM., Blaser M., Hogan A., Evans R.,3rd, Davis AT. A controlled trial of methylprednisolone in the early emergency department treatment of acute asthma in children. Pediatr Emerg Care 1994; 10(6):335-338. Medline
II Supportive (Green) Hospital admission Process ED-MD Bhogal SK., McGillivray D., Bourbeau J., Benedetti A., Bartlett S., Ducharme FM. Early administration of systemic corticosteroids reduces hospital admission rates for children with moderate and severe asthma exacerbation. Ann Emerg Med 2012; 60(1):84-91.e3. Medline

Temperature Monitoring
Level Direction Primary Outcome Patient/Process Setting Reference
II Neutral (Yellow) Sensitivity and Specificity Process Niven DJ., Gaudet JE., Laupland KB., Mrklas KJ., Roberts DJ., Stelfox HT. Accuracy of Peripheral Thermometers for Estimating Temperature: A Systematic Review and Meta-analysis. Ann Intern Med 2015; 163:768-77. Medline


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