Medicine of the Future in America

Predicting the Need for Hospitalization in Children with Acute Asthma: Results (2)

Predicting the Need for Hospitalization in Children with Acute Asthma: Results (2)All patients with initial Sa02 values above 96 percent were discharged home, and none of them subsequently returned to the ER. However, most of the patients had initial Sa02 values between 92 and 96 percent (Fig 1). Similarly, patients with high clinical scores on presentation tended to be hospitalized and patients with low clinical scores tended to be discharged. However, there were patients with high clinical scores who were discharged and patients with low clinical scores who were hospitalized (Fig 1). The clinical score on disposition, ie> after ER treatment, seems to differentiate the groups more clearly, but still there is an area of overlap. It is also not clear from these data which clinical score or Sa02 value, or combination of variables, would be most predictive of outcome. Further analysis was, therefore, required. buy diabetes drugs
Classification Tree Analysis
A number of classification tree analyses were performed and are summarized in Table 4. In the first analysis, only the variables which were measured upon presentation were included as follows: age, sex, number of previous admissions, symptom duration, clinical score, SaO£, PFR, FEVj and FVC. These variables are of specific interest as they are measured when the patient is first seen in the ER. The decision rule predicted that patients with clinical score ^0.75 would be discharged home.

Table 4—Results of Classification Tree Analyses

Analysis VariablesAnalyzed PrespecifiedPenalty CARTPrediction

Rule

ResubstitutionCost Resubstitution Sensitivity % Resubstitution Specificity % Cross t Validated Cost CrossValidated

Sensitivity

%

CrossValidated

Specificity

%

1 Presentation Equal Clinical Score ^0.75 20 79 80 23 79 75
2 Presentation Unequal Clinical Score ^0.65 28 86 72 32 80 72
3 Presentation & Disposition Equal Disposition Clinical Score ^0.65 11 73 90 12 73 95
4 Presentation & Disposition Unequal Disposition Clinical Score ^0.45 18 86 88 20 80 89
5 Individual Clinical score on presentation Equal Dyspnea = 0 23 88 78 23 88 71
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