Admission predictability of children with acute asthma

Abstract

OBJECTIVES:We aimed to evaluate the seasonal variations of acute asthma presentation in children and the utility of the pediatric asthma score (PAS) and its components in early admission prediction.METHODS:As part of a randomized controlled trial addressing the clinical efficacy of budesonide nebulization in the treatment of acute asthma in children, the PAS was measured at baseline, 1st, 2nd, 3rd, and 4th h from the start of medications. Decision of admission was taken at or beyond the 2nd h.RESULTS:Out of a total 906 emergency department (ED) visits with moderate-to-severe acute asthma, 157 children were admitted. June to September had the lowest number of visits. The admission-to-discharge ratio varied throughout the year. During the ED stay, between baseline and 3rd h, admission predictability of the total score improved progressively with a small difference between the 2nd and 3rd h. The total score remained the strongest predictor of admission at every time point compared to its individual components. The drop of PAS from baseline to the 2nd h was not a good predictor of admission. Oxygen saturation (OS) and respiratory rate (RR) had relatively higher predictability than other components.CONCLUSIONS:Decision of admission could be made to many children with moderate-to-severe acute asthma at the 2nd h of ED stay based on their total PAS. OS and RR should be part of any scoring system to evaluate acute asthma in children.

Interrater Reliability of the Pediatric Asthma Score

“…The ROC analysis demonstrated pretreatment PAS to be a poor predictor of the need for hospital admission, regardless of assessor (AUC of 0.62-0.65). This is a lower discriminative ability than previously reported in recent studies of the PAS (AUC of 0.74) 17 and other asthma severity scores (AUC of 0.68-0.75). 10 Based on several prior studies demonstrating significant improvement in AUC after ED treatment, 10,17,18 we anticipate that posttreatment PAS would have an improved AUC, although this was not evaluated in our study.…”

“…This is a lower discriminative ability than previously reported in recent studies of the PAS (AUC of 0.74) 17 and other asthma severity scores (AUC of 0.68-0.75). 10 Based on several prior studies demonstrating significant improvement in AUC after ED treatment, 10,17,18 we anticipate that posttreatment PAS would have an improved AUC, although this was not evaluated in our study. The poor predictive power for arrival PAS to anticipate the need for hospital admission undermines the importance of ongoing clinical assessment of patients' response to therapy in the ED.…”

A Retrospective Audit of Pharmacologic and Non-Pharmacologic Management of Childhood Acute Asthma Exacerbation at Usmanu Danfodiyo University Teaching Hospital, Sokoto: Adherence to Global Treatment Guidelines

“…The odds of long observation in the hospital were also lower for children with mild compared to moderate asthma exacerbations. Various studies with varying methodologies, sample sizes, and different settings had reported factors predicting hospitalization for asthma exacerbations in children ( Lyell et al, 2005 ; Buyuktiryaki et al, 2013 ; Alherbish et al, 2018 ). In a larger multicenter study in Turkey, severity of asthma exacerbations in children was a major predictive factor for hospitalization ( Buyuktiryaki et al, 2013 ).…”