Chest, Vol 98, 1355-1361, Copyright © 1990 by American College of Chest Physicians

ARTICLES

Predicting the need for hospitalization in children with acute asthma

E Kerem, R Tibshirani, G Canny, L Bentur, J Reisman, S Schuh, R Stein and H Levison
Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.

In an attempt to identify factors which influence the decision of physicians to admit patients with acute asthma to the hospital, we studied prospectively 200 children (age 5.6 +/- 3.1 years, mean +/- SD) presenting to our emergency room with acute asthma. The children were assessed on arrival, and on disposition from the Emergency Room by one of the investigators. After obtaining historic data, a clinical score was assigned, and oxygen saturation and pulmonary function were measured. Of the 134 (67 percent) children who were discharged home from the Emergency Room, five returned within seven days and one was subsequently admitted. The clinical score on disposition was the sole variable found to best predict the decision for hospitalization (sensitivity 73 percent, specificity 95 percent). Of the variables obtained at presentation, the resulting decision tree found the clinical score to predict the decision for hospitalization (sensitivity 79 percent, specificity 75 percent). When the individual components of the clinical score were analyzed, the degree of dyspnea, as assessed by the investigator, was chosen as the rule to predict the hospitalization decision (sensitivity 88 percent, specificity 71 percent). We conclude that the decision with respect to the need for hospitalization in acute childhood asthma, is in practice based mainly on careful clinical evaluation. Pulmonary function and SaO2 measurements, although helpful adjuncts in the assessment of acute asthma, do not appear to contribute to the identification of patients who need hospital admission.

This article has been cited by other articles:

				J. Rayner, F. Trespalacios, J. Machan, V. Potluri, G. Brown, L. M. Quattrucci, and G. D. Jay Continuous noninvasive measurement of pulsus paradoxus complements medical decision making in assessment of acute asthma severity. Chest, September 1, 2006; 130(3): 754 - 765. [Abstract] [Full Text] [PDF]

				M. M. Wilson, R. S. Irwin, A. E. Connolly, C. Linden, and M. M. Manno A Prospective Evaluation of the 1-Hour Decision Point for Admission Versus Discharge in Acute Asthma J Intensive Care Med, September 1, 2003; 18(5): 275 - 285. [Abstract] [PDF]

				C. V. Pollack Jr, E. S. Pollack, J. M. Baren, S. R. Smith, P. G. Woodruff, S. Clark, C. A. Camargo, and for the Multicenter Airway Research Collaboration A Prospective Multicenter Study of Patient Factors Associated With Hospital Admission From the Emergency Department Among Children With Acute Asthma Arch Pediatr Adolesc Med, September 1, 2002; 156(9): 934 - 940. [Abstract] [Full Text] [PDF]

				M. W. Stevens and M. H. Gorelick Short-Term Outcomes After Acute Treatment of Pediatric Asthma Pediatrics, June 1, 2001; 107(6): 1357 - 1362. [Abstract] [Full Text] [PDF]