Medicine of the Future in America

Predicting the Need for Hospitalization in Children with Acute Asthma: Results (1)

Of the 200 patients in the study, 66 (33 percent) were hospitalized, and 134 (67 percent) were discharged home. Five of the discharged patients returned to the ER within seven days, and one was subsequently hospitalized. All patients were treated with nebulized albuterol, and in addition, 8 percent received intravenous theophylline, and 8 percent received systemic corticosteroids. The mean age of all patients was 5.6 ±3.1 years (range 0.4 to 16 years). No statistically significant age difference was found in the hospitalized vs the discharged groups (Table 2).

There were 117 male and 83 female subjects (1.4:1) and a similar sex ratio was noted in the hospitalized and discharged groups. When both groups were compared by univariate logistic regression analyses (Tables 2 and 3), most variables were significantly different, although the scatter of the results was high (Fig 1 and 2). A number of factors seems to be potentially predictive, especially Sa02 on presentation, and the clinical score on presentation and on disposition. All patients with an initial Sa02 below 91 percent were admitted to hospital (Fig 1); one patient who presented with an Sa02 value of 90 percent was discharged but returned to the ER within 24 hours, and was then hospitalized.

Table 2—Clinical Characteristics of Patients Who Were Discharged Home and Hospitalized (Mean ± SD)

Discharged Hospitalized
No. of patients 134 66
Male/Female 74/60 43/23
Age, yr 5.8±4.0 5.1±3.9
Previous hospitalizations, No. 1.65±2.71 2.4±3.1
Symptom duration, hr 53.59 ±52.4 33.0±31.5
Clinical score on 0.42 ±0.33 0.85 ± 0.211
presentation
Clinical score on disposition 0.21 ±0.2 0.82±0.24
SaO£ at presentation, % 96.0±2.1 92.5 ±4.3
Sa02 on disposition, % 96.5±2.1 94.0 ±2.91

Table 3—Pulmonary Function Values on Presentation and on Disposition in the Hospitalized and Discharged Patients

Discharged (N = 39) Hospitalizes (N = 15)
FEV,
At presentation 60 ±31 34 ±15
On disposition 77 ±27 52 ±24
PFR
At presentation 51 ±25 33±15
On disposition 67 ±23 49±25
FVC
At presentation 68 ±29 41 ±17
On disposition 81 ±25 58 ±23

Figure-1

Figure 1. Boxplots of the variables: Symptom duration (hours), number of previous hospitalizations, clinical score on presentation and on disposition, and SaOs (%) on presentation and on disposition, grouped as hospitalized or discharged home. The box represents the middle 50 percent of the date. The horizontal line inside the box is the median value. The upper and lower ends of the box show the upper and lower quartiles. The vertical lines show the 95 percent range. Asterisks represent points outside this range.

Figure-2

Figure 2. Boxplots for pulmonary (unction variables on presentation and on disposition. Definition of abbreviations: PFR, peak flow rate; FEV„ forced expiratory volume in 1 second; FVC, forced vital capacity. Values are given in percent predicted. For explanation of boxplot, see Figure 1.

This entry was posted in Asthma and tagged acute asthma, children, Dyspnea, pulmonary function.
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