Screening for poor short-term outcome in acute pediatric asthma

Background: Despite good initial treatment response, many children with acute asthma exacerbations have poor short-term outcomes. Objective: To develop and validate a risk score to screen for poor short-term outcome at the time of emergency department (ED) treatment. Methods: Prospective cohort study of children treated for acute asthma at 2 pediatric EDs. Poor 14-day outcome was defined as any of the following: asthma symptoms still above baseline at 14 days, child missed 5 or more days of school or day care, caretaker missed 5 or more days of school or work, or unscheduled care or admission after the ED visit for worsening symptoms. Results: A total of 1,221 children were enrolled: 852 at the derivation site and 369 at the validation site. Five variables independently associated with poor outcome by logistic regression were used to create a simple linear score: wheezing 2 or more days before the visit, 3 or more acute outpatient asthma visits in the previous 12 months, home use of albuterol, history of severe persistent asthma, and fever at the ED visit. Area under the receiver operating characteristic curve values were 0.66/0.67 for the derivation/validation samples. Two or more features categorized high risk. The test characteristics for the derivation/validation samples are as follows: sensitivity, 0.67/0.62; specificity, 0.61/0.68; likelihood ratio, 1.7/1.9; pretest probability, 33%/47%; and posttest probability, 50%/62%. Conclusions: Information available at the ED visit was used to develop a simple risk score that identifies patients at high risk for poor outcome. The score would be useful in evaluating interventions to improve outcomes by allowing interventions to be targeted to a subgroup most likely to benefit.