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

Arnold DH, Gebretsadik T, Minton PA, Higgins S, Hartert TV
Am J Emerg Med. 2008 26 (4): 473-9

PMID: 18410819 · PMCID: PMC3760484 · DOI:10.1016/j.ajem.2007.05.026

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.

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.

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.

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.

MeSH Terms (14)

Acute Disease Adult Asthma Emergency Service, Hospital Female Humans Length of Stay Male Middle Aged Models, Biological Outcome Assessment, Health Care Patient Admission Prognosis Severity of Illness Index

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