Related Experiment Videos
Predictors of hospitalization in children with acute asthma
K A Keogh1, C Macarthur, P C Parkin
1Division of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Predicting prolonged bronchodilator therapy in acute pediatric asthma is possible. Three or more risk factors indicate a need for hospitalization, while single factors suggest outpatient management is safe.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Medicine
- Clinical Pediatrics
Background:
- Acute asthma exacerbations in children often require bronchodilator therapy.
- Predicting the duration of this therapy is crucial for resource allocation and patient management.
- Identifying factors associated with prolonged treatment can optimize care pathways.
Purpose of the Study:
- To identify clinical and socioeconomic predictors of long-duration bronchodilator therapy in children presenting with acute asthma.
- To develop a predictive model for identifying children at risk for prolonged treatment.
- To inform clinical decision-making regarding disposition and level of care.
Main Methods:
- Prospective cohort study of 278 children aged 12 months or older with acute asthma.
- Collection of clinical and socioeconomic data at baseline and 4 hours post-corticosteroid administration.
- Classification into short (<=12 hours) and long (>12 hours) bronchodilator therapy groups based on albuterol dosing intervals.
- Multiple logistic regression analysis to identify significant predictors of long therapy.
Main Results:
- Five variables significantly predicted long bronchodilator therapy: prior intensive care unit admission, baseline oxygen saturation <=92%, asthma score >=6/9, oxygen saturation <=92% at 4 hours post-corticosteroids, and hourly albuterol dosing interval.
- The presence of three or more predictors was associated with a 91.8% to 99% probability of requiring long therapy.
- Individual factors showed lower predictive power, ranging from 40.6% to 61.8% probability.
Conclusions:
- A combination of three or more identified factors reliably predicts the need for prolonged bronchodilator therapy in pediatric acute asthma.
- This predictive model can help identify children requiring hospitalization.
- Children with only one predictor may be safely managed in emergency or observation settings with close reevaluation.
Objective:
To identify predictors of long duration of bronchodilator therapy in children with acute asthma.
Study Design:
An emergency department prospective cohort study of 278 children > or =12 months of age, with clinical and socioeconomic parameters collected at baseline and 4 hours after administration of corticosteroids. Patients were classified into short and long therapy groups, with interval from first albuterol dose to initiation of administration every 4 hours < or =12 or >12 hours, respectively. Predictors significant by univariate analysis were examined by multiple logistic regression.
Results:
Five variables were associated with long therapy (n = 85) versus short therapy (n = 193): previous intensive care unit admission (odds ratio [OR] 7.2, 95% CI = 1.85, 27.7); baseline oxygen saturation < or =92% (OR 2.6, 95% CI = 0.89, 7.4), asthma score > or =6/9 (OR 2.9, 95% CI = 1.9, 4.37), oxygen saturation < or =92% (OR 6.6, 95% CI = 1.34, 32.0), and hourly albuterol dosing interval (OR 4.3, 95% CI = 0.82, 22.12) 4 hours after administration of corticosteroids. Probability of long therapy was 91.8% to 99% for > or =3 predictors, but only 40.6% to 61.8% for individual factors.
Conclusion:
A combination of 3 or more factors predicts long bronchodilator therapy and signals the need for hospitalization. Children with only one predictor can be safely treated in the emergency department or observation unit and reevaluated.