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Hospitalization patterns in severe acute asthma in children
Author(s) -
Schuh Suzanne,
Johnson David,
Stephens Derek,
Callahan Sheilagh,
Canny Gerald
Publication year - 1997
Publication title -
pediatric pulmonology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.866
H-Index - 106
eISSN - 1099-0496
pISSN - 8755-6863
DOI - 10.1002/(sici)1099-0496(199703)23:3<184::aid-ppul3>3.0.co;2-o
Subject(s) - medicine , asthma , emergency department , placebo , bronchodilator , ipratropium bromide , randomized controlled trial , anesthesia , pediatrics , alternative medicine , pathology , psychiatry
We set out to determine associations between hospitalization and disease severity before and 2 hours after initiation of asthma therapy in the Emergency Department, and to describe the outcome of patients admitted and discharged. This is a retrospective review of data and charts from a randomized, double blind, placebo‐controlled trial (R.C.T.) of 120 asthmatics 5–17 years of age with baseline forced expiratory volume in 1 second (FEV 1 ) <50% predicted, treated with 3 or 1 or 0 doses of nebulized ipratropium added to three albuterol nebulizations administered over 1 hour. None of the clinical parameters measured at baseline were associated with hospitalization. However, by 2 hours after initiation of therapy, both the FEV 1 percent of predicted values (% pred.) and the total asthma score were associated with likelihood of hospital admission. Baseline O 2 saturation <92% indicated a longer hospital stay (75.3 ± 51 hours vs. 43.0 ± 24.4 hours, P = 0.015) and a later onset of infrequent nebulizations (46.7 ± 35.1 vs. 26.6 ± 17.4 hours, P = 0.006). By 2 hours, those with a post‐treatment FEV 1 % pred ≤30% and an asthma score ≥6 of 9 had a high likelihood of hospitalization (86 and 80%, respectively, combined probability 100%), whereas FEV 1 % pred ≥60% and total asthma score <3 were associated with successful discharge (probability of 92 and 83%, respectively). We conclude that pre‐treatment assessments were not associated with hospitalization, while patients with post‐treatment FEV 1 % pred ≤30% and a score ≥6 had high likelihood of hospitalization. Pediatr. Pulmonol. 1997; 23:184–192 © 1997 Wiley‐Liss, Inc.