Assessment of severity measures for acute asthma outcomes: a first step in developing an asthma clinical prediction rule

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• 作者：Donald H. Arnold ; Tebeb Gebretsadik ; Patricia A. Minton ; Stanley Higgins ; Tina V. Hartert
• 刊名：The American Journal of Emergency Medicine
• 出版年：2008
• 出版时间：May 2008
• 年：2008
• 卷：26
• 期：4
• 页码：473-479
• 全文大小：155 K

文摘

ss=""h4"">Objective

As a first step in the development of an asthma prediction rule, our primary objective was to assess the association of 8 candidate predictor variables with 2 clinically relevant asthma outcomes.

ss=""h4"">Methods

Among a cohort of 125 adults hospitalized with an asthma exacerbation, we examined models to identify clinical variables associated with length of stay (LOS) and clinically significant asthma exacerbations within 3 months after hospitalization (3-month exacerbation). Eight candidate predictor variables were chosen, including age, sex, race, pulsus paradoxus, prior endotracheal intubation for asthma, hospitalization within 5 years for asthma, and 2 chronic asthma severity scores.

ss=""h4"">Results

We found independent associations between LOS and pulsus paradoxus (P = .005), prior intubation (P = .03), sex (P = .03), and prior hospitalization (P = .019). Among men, 52 % had a 3-month exacerbation in comparison with 25 % of women; and in multivariable analysis, male sex was independently associated with 3-month exacerbation (adjusted odds ratio = 5.1; 95 % confidence interval = 1.37-18.9; P = .015). Participants with 3-month exacerbation had higher Johns Hopkins Allergy and Asthma Composite (JHAAC) chronic severity scores (median = 77; interquartile range = 57-91) than those who did not (median = 54; interquartile range = 35-69; P < .001) (for 40-unit increase, adjusted OR for 3-month exacerbation = 1.54; 95 % confidence interval = 1.16-2.03; P = .003). In multivariable analysis, male sex and the JHAAC severity score were independently associated with 3-month exacerbation.

ss=""h4"">Conclusions

Elevated pulsus paradoxus, prior intubation for asthma, and 5-year asthma hospitalization are independently associated with LOS. Race, 5-year asthma hospitalization, and JHAAC score predict 3-month asthma exacerbation. These variables warrant consideration for use in the development of an asthma prediction rule.