A prospective evaluation of the 1-hour decision point for admission versus discharge in acute asthma
UMass Chan Affiliations
Department of Medicine, Division of Pulmonary, Allergy and Critical Care MedicineDepartment of Emergency Medicine
Department of Pediatrics
Document Type
Journal ArticlePublication Date
2003-09-24Keywords
Academic Medical CentersAcute Disease
Adolescent
Adult
Albuterol
Algorithms
*Asthma
Bronchodilator Agents
Child
*Decision Support Techniques
Emergency Treatment
Female
Forced Expiratory Volume
Guideline Adherence
Humans
Male
Massachusetts
Middle Aged
*Patient Admission
*Patient Discharge
*Patient Selection
Practice Guidelines as Topic
Prospective Studies
Sensitivity and Specificity
Time Factors
Treatment Outcome
Emergency Medicine
Pediatrics
Metadata
Show full item recordAbstract
Study objectives were to evaluate the 1-hour decision point for discharge or admission for acute asthma; to compare this decision point to the admission recommendations of the Expert Panel Report 2 (EPR-2) guidelines; to develop a model for predicting need for admission in acute asthma. The design used was a prospective preinterventional and postinterventional comparison. The setting was a university hospital emergency department. Participants included 50 patients seeking care for acute asthma. Patients received standard therapy and were randomized to receive albuterol by nebulizer or metered-dose inhaler with spacer every 20 minutes up to 2 hours. Symptoms, physical examination, spirometry, pulsus paradoxus, medication use, and outcome were evaluated. Based on clinical judgment, the attending physician decided to admit or discharge after 1 hour of therapy. Outcome was compared to the EPR-2 guidelines. Post hoc statistical analyses examined predictors of the need for admission from which a prediction model was developed. Maximal accuracy of the admit versus discharge decision occurred at 1 hour of therapy. Using FEV(1) alone as an outcome predictor yielded suboptimal performance. FEV(1) at 1 hour plus ability to lie flat without dyspnea were the best indicators of response and outcome. A model predictive of the need for admission was developed. It performed better (P =.0054) than the admission algorithm of the EPR-2 guidelines. The decision to admit or discharge acute asthmatics from the ED can be made at 1 hour of therapy. No absolute value of peak flow or FEV(1) reliably predicts need for hospital admission. The EPR-2 guideline thresholds for admission are barely adequate as outcome predictors. A clinical model is proposed that may allow more accurate outcome prediction.Source
J Intensive Care Med. 2003 Sep-Oct;18(5):275-85. Link to article on publisher's siteDOI
10.1177/0885066603256044Permanent Link to this Item
http://hdl.handle.net/20.500.14038/43186PubMed ID
15035763Related Resources
Link to Article in PubMedae974a485f413a2113503eed53cd6c53
10.1177/0885066603256044