Asthma vital signs at triage

Home or admission (ASTHmA)

Timothy Horeczko, Garen J Wintemute

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objectives: Commonly used acute asthma scoring systems assess severity of symptoms, whereas other clinical models aim to predict hospitalization; all rely on a measure of response to treatment and use the same criteria across age ranges. This may not reflect a child's changing physiology and response to illness as he or she grows older. This study aimed to find age-specific objective predictors of hospitalization readily known at triage. The goal is to identify rapidly those who will likely need admission regardless of treatment administered or response to aggressive treatment in the emergency department (ED). Methods: Children between 1 and 18 years of age with a final primary ED International Classification of Diseases, Ninth Revision, diagnosis of asthma or asthma-related spectrum of disease were studied using data from the National Hospital Ambulatory Medical Care Survey. The primary outcome was hospital admission (observation unit, ward, monitored, or pediatric intensive care unit). Triage vital signs, mode of arrival, recent visits, emergency severity index score, as well as demographic and socioeconomic factors were incorporated into age-specific forward-selection multiple logistic regression models. Results: In 2,454,983 ED visits for asthma or reactive airway disease among children 1 to 18 years of age, patterns of vital sign predictors for admission varied by age group. Across all ages, diastolic hypotension at triage was an early, consistent, independent predictor of admission, especially in 1- to 3-year-olds (odds ratio, 6.27; 95% confidence interval, 6.01-6.54) and 3- to 6-year-olds (odds ratio, 17.95; 95% confidence interval, 16.80-19.17). Conclusions: Age-specific assessment is important in the evaluation of acute asthma or reactive airway exacerbation. Diastolic hypotension may serve as an early warning indicator of severity of disease and need for hospitalization. Variability by age group in vital sign predictor for admission calls for further development or refinement of agespecific asthma assessment tools.

Original languageEnglish (US)
Pages (from-to)175-182
Number of pages8
JournalPediatric Emergency Care
Volume29
Issue number2
DOIs
StatePublished - Feb 2013

Fingerprint

Vital Signs
Triage
Asthma
Hospital Emergency Service
Hospitalization
Hypotension
Age Groups
Logistic Models
Odds Ratio
Confidence Intervals
Health Care Surveys
Pediatric Intensive Care Units
International Classification of Diseases
Emergencies
Therapeutics
Observation
Demography

Keywords

  • Acute asthma
  • Asthma scores
  • Emergency department triage

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Emergency Medicine

Cite this

Asthma vital signs at triage : Home or admission (ASTHmA). / Horeczko, Timothy; Wintemute, Garen J.

In: Pediatric Emergency Care, Vol. 29, No. 2, 02.2013, p. 175-182.

Research output: Contribution to journalArticle

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