Abstract
In an attempt to define guidelines for the assessment of acute asthma, we evaluated 205 patients who presented to the emergency room for treatment of asthma. Of the 205, 120 were successfully treated and discharged from the emergency room, 45 were hospitalized, and 40 were treated and discharged from the emergency room but had relapses within 10 days. A predictive index using a combination of presenting factors was developed: pulse rate ≥120 per minute, respiratory rate ≥30 per minute, pulsus paradoxus ≥18 mm Hg, peak expiratory flow rate ≤120 liters per minute, moderate to severe dyspnea, accessory-muscle use, and wheezing. The index ranged from 0 to 7, increasing with the severity of symptoms. The index scores of the relapse group (4.9±1.0) and the admitted group (5.1±1.0) were both significantly different (P<0.001) from that of the successfully treated group (1.6±1.2). An index of 4 or higher was 95 per cent accurate in predicting the risk of relapse and 96 per cent accurate in predicting the need for hospitalizaron. (N Engl J Med. 1981; 305:783–9.)
PATIENTS with severe bronchial asthma are usually hospitalized only after a trial of therapy in the emergency room has failed. Consequently, many patients spend long hours in a busy emergency room before a decision to hospitalize or discharge is made. In spite of this, relapse rates in patients treated and discharged from the emergency room remain as high as 26 to 30 per cent, necessitating further emergencyroom care.
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It has been well established that individual clinical and laboratory measurements may not reliably predict which patients have severe bronchial asthma or which are at risk for relapse after discharge.
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