Buyuktiryaki A Betul, Civelek Ersoy, Can Demet, Orhan Fazıl, Aydogan Metin, Reisli Ismail, Keskin Ozlem, Akcay Ahmet, Yazicioglu Mehtap, Cokugras Haluk, Yuksel Hasan, Zeyrek Dost, Kocak A Kadir, Sekerel Bulent E
Pediatric Allergy and Asthma Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey.
J Emerg Med. 2013 May;44(5):919-27. doi: 10.1016/j.jemermed.2012.10.015. Epub 2013 Jan 16.
Acute asthma is one of the most common medical emergencies in children. Appropriate assessment/treatment and early identification of factors that predict hospitalization are critical for the effective utilization of emergency services.
To identify risk factors that predict hospitalization and to compare the concordance of the Modified Pulmonary Index Score (MPIS) with the Global Initiative for Asthma (GINA) guideline criteria in terms of attack severity.
The study population was composed of children aged 5-18 years who presented to the Emergency Departments (ED) of the tertiary reference centers of the country within a period of 3 months. Patients were evaluated at the initial presentation and the 1(st) and 4(th) hours.
Of the 304 patients (median age: 8.0 years [interquartile range: 6.5-9.7]), 51.3% and 19.4% required oral corticosteroids (OCS) and hospitalization, respectively. Attack severity and MPIS were found as predicting factors for hospitalization, but none of the demographic characteristics collected predicted OCS use or hospitalization. Hospitalization status at the 1(st) hour with moderate/severe attack severity showed a sensitivity of 44.1%, specificity of 82.9%, positive predictive value of 38.2%, and negative predictive value of 86.0%; for MPIS ≥ 5, these values were 42.4%, 85.3%, 41.0%, and 86.0%, respectively. Concordance in prediction of hospitalization between the MPIS and the GINA guideline was found to be moderate at the 1(st) hour (κ = 0.577).
Attack severity is a predictive factor for hospitalization in children with acute asthma. Determining attack severity with MPIS and a cut-off value ≥ 5 at the 1(st) hour may help physicians in EDs. Having fewer variables and the ability to calculate a numeric value with MPIS makes it an easy and useful tool in clinical practice.
急性哮喘是儿童最常见的医疗急症之一。进行适当的评估/治疗以及早期识别预测住院的因素对于有效利用急诊服务至关重要。
识别预测住院的风险因素，并比较改良肺指数评分（MPIS）与全球哮喘防治创议（GINA）指南标准在发作严重程度方面的一致性。
研究人群包括在3个月内到该国三级参考中心急诊科就诊的5至18岁儿童。在患者初次就诊时以及第1小时和第4小时进行评估。
在304例患者（中位年龄：8.0岁[四分位间距：6.5 - 9.7]）中，分别有51.3%和19.4%的患者需要口服糖皮质激素（OCS）和住院治疗。发作严重程度和MPIS被发现是住院的预测因素，但所收集的人口统计学特征均未预测OCS的使用或住院情况。在第1小时发作严重程度为中度/重度时的住院状态显示敏感性为44.1%，特异性为82.9%，阳性预测值为38.2%，阴性预测值为86.0%；对于MPIS≥5，这些值分别为42.4%、85.3%、41.0%和86.0%。发现MPIS与GINA指南在第1小时预测住院方面的一致性为中等（κ = 0.577）。
发作严重程度是急性哮喘儿童住院的预测因素。在第1小时用MPIS确定发作严重程度且临界值≥5可能有助于急诊科医生。MPIS变量较少且能够计算数值，使其成为临床实践中一种简单且有用的工具。
