Diner B, Brenner B, Camargo C A
Department of Emergency Medicine, The Brooklyn Hospital Center Weill College of Medicine, Cornell University, Brooklyn, New York 11201, USA.
J Asthma. 2001 Apr;38(2):127-32. doi: 10.1081/jas-100000030.
Percent predicted peak expiratory flow (PEF) is used to determine the severity of asthma exacerbation and the appropriateness of discharge from the emergency department (ED). The 1995 Global Initiative for Asthma and 1997 National Asthma Education and Prevention Program guidelines recommend using a patient's "personal best" PEF, if available, as a better measurement than the predicted PEF obtained from population-based nomograms. We evaluated the accuracy of personal best PEF as provided by inner-city ED patients with acute asthma. One hundred four patients with acute asthma agreed to return to the ED for repeat PEF measurements on days 3, 7, 12, 21, and 24 after their initial ED visits for acute asthma. At the ED visit, only 29% (30/104) of patients were able to report a personal best PEF. Over the 24 days of follow-up, 45% (10/22) of these patients had a measured PEF greater than their reported personal best. If a predicted PEF of at least 70% was used as the criterion for ED discharge, as several asthma guidelines recommend, then using patients' reported personal best PEF would have led to inappropriate ED discharge for some patients.
预计呼气峰值流速（PEF）百分比用于确定哮喘急性发作的严重程度以及急诊科（ED）出院的适宜性。1995年全球哮喘防治创议及1997年国家哮喘教育与预防计划指南建议，如果可行，使用患者的“个人最佳”PEF，这比根据基于人群的列线图获得的预计PEF是更好的测量指标。我们评估了患有急性哮喘的市中心急诊科患者提供的个人最佳PEF的准确性。104例急性哮喘患者同意在首次因急性哮喘到急诊科就诊后的第3、7、12、21和24天返回急诊科进行重复PEF测量。在急诊科就诊时，只有29%（30/104）的患者能够报告个人最佳PEF。在24天的随访中，这些患者中有45%（10/22）的实测PEF高于其报告的个人最佳值。如果像一些哮喘指南所建议的那样，将至少70%的预计PEF用作急诊科出院标准，那么使用患者报告的个人最佳PEF会导致一些患者不适合从急诊科出院。
