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dc.contributor.authorWilson, Mark M.
dc.contributor.authorIrwin, Richard S.
dc.contributor.authorConnolly, Ann E.
dc.contributor.authorLinden, Christopher
dc.contributor.authorManno, Mariann M.
dc.date2022-08-11T08:10:09.000
dc.date.accessioned2022-08-23T16:57:37Z
dc.date.available2022-08-23T16:57:37Z
dc.date.issued2003-09-24
dc.date.submitted2012-03-09
dc.identifier.citationJ Intensive Care Med. 2003 Sep-Oct;18(5):275-85. <a href="http://dx.doi.org/10.1177/0885066603256044">Link to article on publisher's site</a>
dc.identifier.issn0885-0666 (Linking)
dc.identifier.doi10.1177/0885066603256044
dc.identifier.pmid15035763
dc.identifier.urihttp://hdl.handle.net/20.500.14038/43186
dc.description.abstractStudy 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.
dc.language.isoen_US
dc.relation<a href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Retrieve&list_uids=15035763&dopt=Abstract">Link to Article in PubMed</a>
dc.relation.urlhttp://dx.doi.org/10.1177/0885066603256044
dc.subjectAcademic Medical Centers
dc.subjectAcute Disease
dc.subjectAdolescent
dc.subjectAdult
dc.subjectAlbuterol
dc.subjectAlgorithms
dc.subject*Asthma
dc.subjectBronchodilator Agents
dc.subjectChild
dc.subject*Decision Support Techniques
dc.subjectEmergency Treatment
dc.subjectFemale
dc.subjectForced Expiratory Volume
dc.subjectGuideline Adherence
dc.subjectHumans
dc.subjectMale
dc.subjectMassachusetts
dc.subjectMiddle Aged
dc.subject*Patient Admission
dc.subject*Patient Discharge
dc.subject*Patient Selection
dc.subjectPractice Guidelines as Topic
dc.subjectProspective Studies
dc.subjectSensitivity and Specificity
dc.subjectTime Factors
dc.subjectTreatment Outcome
dc.subjectEmergency Medicine
dc.subjectPediatrics
dc.titleA prospective evaluation of the 1-hour decision point for admission versus discharge in acute asthma
dc.typeJournal Article
dc.source.journaltitleJournal of intensive care medicine
dc.source.volume18
dc.source.issue5
dc.identifier.legacycoverpagehttps://escholarship.umassmed.edu/peds_emergency/3
dc.identifier.contextkey2652426
html.description.abstract<p>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.</p>
dc.identifier.submissionpathpeds_emergency/3
dc.contributor.departmentDepartment of Medicine, Division of Pulmonary, Allergy and Critical Care Medicine
dc.contributor.departmentDepartment of Emergency Medicine
dc.contributor.departmentDepartment of Pediatrics
dc.source.pages275-85


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