No written guidelines or protocols are used in our ER with respect either to treatment of acute asthma or the need for hospital admission. The latter decision is based on the clinical judgment of the attending physician. It is possible that some children in our series were hospitalized unnecessarily. It is not possible on the basis of our data to identify patients who were hospitalized and might have been safely treated at home. However, it should be pointed out that easy access to hospital and earlier admission has been shown to reduce mortality and morbidity in asthma, suggesting that physicians should admit patients to hospital if in doubt.
One should remember that the decision with respect to hospitalization is determined in part by social and behavioral factors that are specific to the patient population (eg. expected parental compliance, availability of compressor in younger children), or specific to the institution (eg, distance from residence). Therefore, the sensitivity and specificity of the prediction rule presented in this work may vary in predicting the outcome of acute asthma when applied in other institutions. asthma inhalers
In summary, our study shows that careful ongoing clinical evaluation is superior to reliance on pulmonary function and Sa02 measurements in predicting the need for hospitalization in acute childhood asthma.