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Predicting the need for hospitalization in acute childhood asthma using end-tidal capnography
Sergey Kunkov1, Vincent Pinedo, Ellen Johnson Silver
1Division of Pediatric Emergency Medicine, Jacobi Medical Center, Bronx, NY 10461, USA. kunkovmd@optonline.net
Insights
End-tidal capnography may predict hospitalization in children with asthma exacerbations. A low baseline capnography ratio (<0.15) identified children at higher risk for admission, offering an objective tool for risk assessment.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Physiology
Background:
- Acute asthma exacerbations in children frequently lead to emergency department visits and hospitalizations.
- Accurate prediction of hospitalization is crucial for timely intervention and resource allocation.
Purpose of the Study:
- To evaluate the effectiveness of end-tidal capnography in predicting the need for hospitalization in pediatric patients experiencing acute asthma exacerbations.
Main Methods:
- A prospective cohort study involving children aged 5-17 presenting with acute asthma.
- End-tidal capnography was performed at baseline, measuring a specific ratio (plateau length/respiratory rate).
- The sensitivity and specificity of this ratio for predicting hospitalization were assessed.
Main Results:
- The study included 37 children; 12 were hospitalized and 25 discharged.
- A baseline capnography ratio <0.15 was significantly associated with hospitalization (83.3% of hospitalized vs. 32% of discharged).
- A ratio <0.15 increased the odds of hospitalization by 18.77 times, even after controlling for asthma severity.
Conclusions:
- Baseline end-tidal capnography shows promise as an objective, effort-independent tool for identifying children with asthma exacerbations at high risk of hospitalization.
- This non-invasive method could aid clinicians in decision-making within the pediatric emergency department setting.
Objective:
To explore the utility of end-tidal capnography for predicting hospitalization in acute childhood asthma.
Design, Setting, And Participants:
A prospective cohort study of a convenience sample of children 5 to 17 years of age presenting to a pediatric emergency department with an acute asthma exacerbation. Capnography was performed at baseline. The length of the plateau portion of the baseline capnograph waveform was measured in millimeters and divided by the respiratory rate at the time of the measurement to create a ratio. The sensitivity and specificity of the baseline capnography ratio for predicting hospitalization were assessed.
Main Outcome Measures:
Hospitalization versus discharge from the pediatric emergency department.
Results:
Thirty-seven patients were enrolled. The hospitalized (n = 12) and discharged (n = 25) groups did not differ in terms of any demographic or baseline characteristics except for pulmonary score and the median baseline capnography ratio. The median ratio was 0.15. Ten (83.3%) of 12 of patients who were hospitalized had a baseline ratio less than 0.15 compared with 8 (32%) of 25 of patients who were discharged from pediatric emergency department (P < 0.05). Controlling for baseline asthma severity, the odds of being hospitalized if the baseline capnography ratio was less than 0.15 were 18.77 (95% confidence interval, 1.91-184.69).
Conclusion:
This pilot study suggests that baseline capnography may be useful as an objective effort-independent tool for identifying children with an asthma exacerbation who are at risk for hospitalization.
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