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Clinical predictors of hospitalization in an acute attack of bronchial asthma
G R Sethi1, S Kapoor, H P Sachdev
1Department of Pediatrics, Maulana Azad Medical College, New Delhi.
Insights
Clinical factors like pulsus paradoxus, young age, and severe accessory muscle use predict hospitalization in children with acute asthma. These factors accurately identify children needing hospital care, simplifying asthma management.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Predictors
Background:
- Acute bronchial asthma attacks in children require prompt assessment for hospitalization.
- Identifying predictors of hospitalization is crucial for effective resource allocation and timely intervention.
Purpose of the Study:
- To identify clinical predictors of hospitalization in children aged 2-12 years experiencing acute bronchial asthma attacks.
- To determine if clinical variables alone are sufficient for predicting hospitalization needs.
Main Methods:
- Seventy-five children with acute asthma were evaluated, with data collected before therapy.
- Multivariate analysis was used to identify independent predictors of hospitalization.
- Hospitalized children were compared with those discharged without relapse.
Main Results:
- Independent clinical predictors for hospitalization included pulsus paradoxus (> 10 mm Hg), younger age (< 5 years), and severe accessory muscle use.
- A model using any two of these three clinical predictors demonstrated high sensitivity (90%) and specificity (96%).
- Investigative variables like low pH and polymorphonuclear leucocytosis showed predictive value but did not improve the clinical model's predictability.
Conclusions:
- Clinical variables are sufficient for identifying children with acute bronchial asthma who require hospitalization at presentation.
- The identified clinical predictors allow for accurate and efficient triage of pediatric asthma patients.
Abstract:
The present study was undertaken to identify the clinical predictors of hospitalization in an acute attack of bronchial asthma in subjects aged 2-12 years. Seventy five children with an acute attack of bronchial asthma were evaluated. A detailed clinical history and examination was recorded and baseline investigations sent before starting therapy. All subjects were treated with injection adrenaline (two doses) and those who did not respond were hospitalized. Twenty subjects who were hospitalized were compared with 32 cases who were discharged and did not have a relapse on follow up. After multivariate analysis, the factors independently predictive of hospitalization were, pulsus paradoxus (> 10 mm Hg; OR = 1.02), younger age (below 5 years, OR = 0.98) and severe accessory muscle use (OR = 89.6). Presence of any 2 of these 3 clinical predictors has a high sensitivity (90%) and specificity (96%). The investigative variables significant after multivariate analysis were low pH (OR = 0.00) and polymorphonuclear leucocytosis (> 70%) on peripheral smear (OR = 1.12). The sensitivity of this model was similar (90%) but specificity was lower (90.6%). The addition of investigative variables to clinical model did not improve the predictability. It is concluded that it is possible to identify at presentation, children with acute bronchial asthma who require hospitalization and clinical variables are sufficient for this purpose.