Arnold Donald H, Sills Marion R, Walsh Colin G
aDivision of Emergency Medicine, Department of Pediatrics and Center for Asthma Research, Vanderbilt University School of Medicine, Nashville, Tennessee bSection of Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado cDepartment of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
Curr Opin Allergy Clin Immunol. 2016 Jun;16(3):201-9. doi: 10.1097/ACI.0000000000000259.
The aim of the present review was to discuss the challenges around clinical decision-making for hospitalization of children with acute asthma exacerbations and the development, internal validation, and future potential of the asthma prediction rule (APR) to provide meaningful clinical decision-support that might decrease unnecessary hospitalizations.
The APR was developed and internally validated using predictor variables available before treatment in the emergency department, and performed well to predict 'need-for-hospitalization.' Oxygen saturation on room air and expiratory phase prolongation were most strongly associated with need-for-hospitalization.
Research on prediction rules in pediatric asthma is rare. We developed and internally validated the APR using clinically intuitive predictor variables that are available at the bedside. Before incorporation into electronic decision-support the APR must undergo external validation and an impact analysis to determine if use of this tool will change clinician behavior and improve patient outcomes.
本综述旨在探讨儿童急性哮喘加重期住院临床决策面临的挑战，以及哮喘预测规则（APR）的开发、内部验证及其未来潜力，以提供有意义的临床决策支持，减少不必要的住院。
APR利用急诊科治疗前可用的预测变量进行开发和内部验证，在预测“住院需求”方面表现良好。室内空气中的氧饱和度和呼气期延长与住院需求的相关性最强。
儿科哮喘预测规则的研究很少。我们利用床边可用的临床直观预测变量开发并内部验证了APR。在纳入电子决策支持之前，APR必须经过外部验证和影响分析，以确定使用该工具是否会改变临床医生的行为并改善患者结局。
