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Prediction Model for Croup Admission Need
Walid Maalouli1, Ashley Petersen1, Jonathan Strutt1
1University of Minnesota, Minneapolis, Minnesota.
Insights
A new predictive model can help identify croup patients needing hospitalization. This tool aids emergency department (ED) decision-making, especially when pediatric expertise is limited.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Decision Support Systems
- Respiratory Illnesses
Background:
- Croup is a common pediatric respiratory illness presenting to emergency departments.
- Accurate risk stratification for croup is crucial for appropriate patient management and resource allocation.
- Existing methods for predicting croup hospitalization may lack precision.
Purpose of the Study:
- To develop and validate a predictive model for identifying croup patients at risk of hospitalization and requiring respiratory intervention.
- To compare the model's predictive performance against emergency department (ED) provider assessments.
Main Methods:
- Retrospective analysis of 2951 croup patients from 2019-2020 across three hospitals.
- Utilized demographics, clinical history, Westley croup scores, and ED treatments (dexamethasone, racemic epinephrine) as predictors.
- Employed L1-penalized logistic regression to build the admission need prediction model.
Main Results:
- The final model included disposition Westley croup scores, racemic epinephrine doses, prior dexamethasone, and intubation history.
- The model achieved 66% sensitivity and 99% negative predictive value for predicting admission need.
- Emergency department providers demonstrated slightly higher sensitivity (72%) but lower specificity (94%) compared to the model.
Conclusions:
- The developed predictive model shows promise in supporting clinical decision-making for croup patients in the ED.
- The model can potentially enhance management decisions, particularly in settings with limited pediatric expertise.
- Further validation may be warranted to optimize its clinical utility.
Objectives:
This study aims to generate a predictive model stratifying the probability of requiring hospitalization and inpatient respiratory intervention for croup patients presenting to the emergency department (ED), and secondarily to compare the model's performance with that of ED providers.
Methods:
Retrospective data was collected on croup patients presenting to the EDs of 2 pediatric and 1 community hospital from 2019 to 2020, including demographics, preexisting conditions, and history of croup. The ED length of stay, previous dexamethasone administration, time to ED dexamethasone, number of ED racemic epinephrine doses, viral testing, and ED revisits were also recorded. Westley croup scores were derived at ED presentation and final disposition. For admitted patients, any respiratory interventions were recorded. Admission need was defined as either admitted and required an inpatient intervention or not admitted with ED revisit. A prediction model for admission need was fit using L1-penalized logistic regression.
Results:
We included 2951 patients in the study, 68 (2.3%) of which needed admission. The model's predictors were disposition Westley croup scores, number of ED racemic epinephrine doses, previous dexamethasone administration, and history of intubation. The model's sensitivity was 66%, specificity was 91%, positive predictive value was 15%, and negative predictive value was 99%. ED providers' performance had a sensitivity of 72%, a specificity of 94%, a positive predictive value of 23%, and a negative predictive value of 99%.
Conclusions:
The croup admission need predictive model appears to support clinical decision making in the ED, with the potential to improve decision making when pediatric expertise is limited.
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