Gorelick Marc, Scribano Philip V, Stevens Martha W, Schultz Theresa, Shults Justine
Department of Pediatrics, Medical College of Wisconsin and Children's Research Institute, Milwaukee, WI, USA.
Pediatr Emerg Care. 2008 Nov;24(11):735-44. doi: 10.1097/PEC.0b013e31818c268f.
To develop and validate predictive models to determine the need for hospitalization in children treated for acute asthma in the emergency department (ED).
Prospective cohort study of children aged 2 years and older treated at 2 pediatric EDs for acute asthma. The primary outcome was successful ED discharge, defined as actual discharge from the ED and no readmission for asthma within 7 days, versus need for extended care. Among those defined as requiring extended care, a secondary outcome of inpatient care (>24 hours) or short-stay care (<24 hours) was defined. Logistic regression and recursive partitioning were used to create predictive models based on historical and clinical data from the ED visit. Models were developed with data from 1 ED and validated in the other.
There were 852 subjects in the derivation group and 369 in the validation group. A model including clinical score (Pediatric Asthma Severity Score) and number of albuterol treatments in the ED distinguished successful discharge from need for extended care with an area under the receiver-operator characteristic curve of 0.89 (95% confidence interval [CI], 0.87-0.92) in the derivation group and 0.92 (95% CI, 0.89-0.95) in the validation group. Using a score of 5 or more as a cutoff, the likelihood ratio positive was 5.2 (95% CI, 4.2-6.5), and the likelihood ratio negative was 0.22 (95% CI, 0.17-0.28). Among those predicted to need extended care, a classification tree using number of treatments in the ED, clinical score at end of ED treatment, and initial pulse oximetry correctly classified 63% (95% CI, 56-70) of the derivation group as short stay or inpatient, and 62% (95% CI, 55-68) of the validation group.
Successful discharge from the ED for children with acute asthma can be predicted accurately using a simple clinical model, potentially improving disposition decisions. However, predicting correct placement of patients requiring extended care is problematic.
开发并验证预测模型，以确定在急诊科（ED）接受急性哮喘治疗的儿童是否需要住院治疗。
对两家儿科急诊科中2岁及以上接受急性哮喘治疗的儿童进行前瞻性队列研究。主要结局是急诊成功出院，定义为实际从急诊科出院且7天内无哮喘再入院，与之相对的是需要延长护理。在那些被定义为需要延长护理的儿童中，定义了住院护理（>24小时）或短期护理（<24小时）的次要结局。使用逻辑回归和递归划分方法，根据急诊就诊的历史和临床数据创建预测模型。模型利用一家急诊科的数据开发，并在另一家急诊科进行验证。
推导组有852名受试者，验证组有369名。一个包含临床评分（儿童哮喘严重程度评分）和急诊科沙丁胺醇治疗次数的模型，在推导组中区分成功出院和需要延长护理的受试者工作特征曲线下面积为0.89（95%置信区间[CI]，0.87 - 0.92），在验证组中为0.92（95%CI，0.89 - 0.95）。以5分或更高作为临界值，阳性似然比为5.2（95%CI，4.2 - 6.5），阴性似然比为0.22（95%CI，0.17 - 0.28）。在那些预计需要延长护理的儿童中，一个使用急诊科治疗次数、急诊治疗结束时的临床评分和初始脉搏血氧饱和度的分类树，在推导组中将63%（95%CI，56 - 70）正确分类为短期或住院护理，在验证组中为62%（95%CI，55 - 68）。
使用一个简单的临床模型可以准确预测急性哮喘儿童从急诊科成功出院的情况，这可能会改善处置决策。然而，预测需要延长护理的患者的正确安置存在问题。
Zotero 插件