A predictor index for hospitalization for patients with acute asthmatic attack

Thirty-nine patients, aged 14 to 50 years (mean 33), were treated for an acute asthmatic attack in the hospital emergency room. A scored index was estimated on admission for each patient, based on pulse, respiratory and peak expiratory flow rates (PEFR), amplitude of paradoxical pulse and degree of dyspnea, wheezing and accessory muscle use. All patients were treated according to a standard protocol including oxygen, fluids, salbutamol inhalations and aminophylline infusions, with hydrocortisone infusion in selected patients. The decision to hospitalize of discharge was based on clinical grounds and was taken after 4 to 8 h of treatment without prior knowledge of the patient's index. The mean index of 13 hospitalized patients (Group 1) was 4.5 +/- 1.7 (mean +/- 2 SD), compared with 4.3 +/- 1.3 of 7 patients who were discharged but returned for additional treatment within 10 days (Group 2). Both indices were significantly higher than that of 19 patients who were discharged and remained well (2.5 +/- 1.5) (Group 3). The most important differentiating parameters were the degree of dyspnea, wheezing and PEFR. We conclude that patients with scored indices of greater than 4 should be hospitalized immediately, those with indices less than 4 could probably be discharged with relative safety, and patients with an index of 4 should be considered individually, with dyspnea, wheezing and PEFR being the major criteria for the decision.