Early prediction of the need for hospitalization in children with acute asthma.

We studied 133 asthmatic children in the emergency room who were aged 4 to 17 years and who were not receiving ongoing training in pulmonary function testing, to determine whether spirometry correlated with the outcome of the emergency treatment of the acute attack and with relapse during the next four days. A clinical score derived from the physical exam was obtained at the time of spirometry. Patients were hospitalized or discharged home based solely on their clinical response to therapy. The pediatrician making that decision was blinded to the results of the spirometry. The initial pretreatment clinical score or spirometry alone identified the majority of patients hospitalized, but each falsely identified many discharged patients who did not relapse, 20 percent and 15 percent, respectively. Predictive criteria for hospitalization, combining spirometry with a careful clinical evaluation prior to the start of emergency treatment, substantially reduced the number of falsely identified patients. With use of the predictive criteria, the majority of children admitted to the hospital would have been identified hours before that decision was made on clinical grounds alone (5.5 +/- 0.7 hrs). This study suggests a role for spirometry as an adjunct to clinical evaluation in the early identification of the need for hospitalization of acutely ill asthmatic children.