Eliakim R, Halperin Y, Menczel J
Isr J Med Sci. 1984 Mar;20(3):202-6.
Thirty-nine patients, aged 14 to 50 years (mean 33), were treated for an acute asthmatic attack in the hospital emergency room. A scored index was estimated on admission for each patient, based on pulse, respiratory and peak expiratory flow rates (PEFR), amplitude of paradoxical pulse and degree of dyspnea, wheezing and accessory muscle use. All patients were treated according to a standard protocol including oxygen, fluids, salbutamol inhalations and aminophylline infusions, with hydrocortisone infusion in selected patients. The decision to hospitalize of discharge was based on clinical grounds and was taken after 4 to 8 h of treatment without prior knowledge of the patient's index. The mean index of 13 hospitalized patients (Group 1) was 4.5 +/- 1.7 (mean +/- 2 SD), compared with 4.3 +/- 1.3 of 7 patients who were discharged but returned for additional treatment within 10 days (Group 2). Both indices were significantly higher than that of 19 patients who were discharged and remained well (2.5 +/- 1.5) (Group 3). The most important differentiating parameters were the degree of dyspnea, wheezing and PEFR. We conclude that patients with scored indices of greater than 4 should be hospitalized immediately, those with indices less than 4 could probably be discharged with relative safety, and patients with an index of 4 should be considered individually, with dyspnea, wheezing and PEFR being the major criteria for the decision.
39名年龄在14至50岁（平均33岁）的患者因急性哮喘发作在医院急诊室接受治疗。入院时根据脉搏、呼吸频率、呼气峰值流速（PEFR）、奇脉幅度以及呼吸困难、喘息和辅助肌使用程度为每位患者评估一个评分指数。所有患者均按照标准方案进行治疗，包括吸氧、补液、沙丁胺醇吸入和氨茶碱输注，部分患者还接受氢化可的松输注。住院或出院的决定基于临床情况，在治疗4至8小时后做出，事先并不知晓患者的指数。13名住院患者（第1组）的平均指数为4.5±1.7（平均值±2标准差），而7名出院但在10天内返回接受进一步治疗的患者（第2组）的平均指数为4.3±1.3。这两个指数均显著高于19名出院且情况良好的患者（2.5±1.5）（第3组）。最重要的鉴别参数是呼吸困难、喘息程度和PEFR。我们得出结论，评分指数大于4的患者应立即住院，指数小于4的患者可能相对安全地出院，指数为4的患者应单独考虑，呼吸困难、喘息和PEFR是做出决定的主要标准。
