Published Online: November 25, 2014
Acute asthma attacks (exacerbations) are the most frequent reason for childhood hospitalization in North America. However, clinicians have limited tools to help them decide whether a child having an exacerbation needs to be hospitalized. Clinical prediction rules are decision-making tools that incorporate patient characteristics to predict the probability of an outcome such as the need for hospitalization during an exacerbation.
In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Arnold and colleagues report on their development of the Asthma Prediction Rule (APR) to predict Need for Hospitalization, defined as hospital length of stay > 24 hours or relapse within 48 hours if discharged to home. The authors studied a cohort of children ages 5 to 17 years with asthma exacerbations cared for in their tertiary children’s hospital emergency department. They measured 15 patient characteristics that are available at the bedside before treatment and mathematically modeled their 15-component, full-model APR as well as a 5-component abbreviated APR to predict the actual Need for Hospitalization. They then assessed how well each APR performed using statistical simulations within their cohort, referred to as internal validation.
Over a 5-year period the authors studied 928 children, most of whom had moderate severity exacerbations. The full-model and abbreviated APR’s both performed well in predicting Need for Hospitalization. For both APR’s blood oxygen saturation on room air and prolongation of the exhalation phase of breathing were most strongly predictive of Need for Hospitalization. For each APR the authors provided a nomogram for use at the bedside as well as mathematic formulae for incorporation into electronic decision-support.
Decisions for hospitalization are most challenging for children with moderate-severity exacerbations, the population represented by the authors’ study. The APR might facilitate decision-making for hospitalization at the time a child comes to an emergency department and before treatment. Use of the APR in this way might enhance decision-support for clinicians and parents, decrease resource utilization, and decrease the burden of this disease on children and families. However, the performance of the APR and the impact that use of the APR has on these outcomes must be assessed before it is widely used for patient care.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.