• Nitai A Levy, Shereen Hawash, Riad Shiekh, and Idit Pasternak.
• Department of Pediatric Emergency, Ruth Children's Hospital, Rambam Health Care Campus, Haifa, Israel; Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel. Electronic address: nitai.tal@gmail.com.
• Am J Emerg Med. 2025 Jan 10; 90: 788078-80.

ObjectiveTo evaluate triage nurses' clinical judgment in determining short acting β2-agonist bronchodilator therapy need for children with shortness of breath in the pediatric emergency department, without prior physician assessment.MethodsThis prospective study compared decision-making between triage nurses and physicians regarding bronchodilator inhalation therapy necessity. Trained nurses assessed children aged 2-18 with shortness of breath, including history-taking, vital signs, and lung auscultation. Nurses made short acting β2-agonist therapy decisions based on predefined criteria. Pediatric specialists independently evaluated patients and recorded their decision.ResultsAnalysis of 62 assessments from 31 patients showed no statistically significant difference between nurses and doctors in administering inhaled bronchodilators (nurses: 87.1 %, doctors: 83.9 %). Clinical sign detection was similar, except for tachypnea (nurses: 48.4 %, doctors: 71 %, P = 0.07). McNemar's test and Cohen's kappa coefficient demonstrated strong nurse-doctor correlation per patient (accuracy: 83.9 %, P = 0.1; kappa: 0.351).ConclusionsNurses excelled in recognizing certain clinical signs but showed lower compatibility in others. For severe cases, nurses consistently identified patients needing additional treatments.Copyright © 2025 Elsevier Inc. All rights reserved.

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