Predictors of hospitalization in children with acute asthma

Objective: To identify predictors of long duration of bronchodilator therapy in children with acute asthma. Study design: An emergency department prospective cohort study of 278 children greater than or equal to 12 months of age, with clinical and socioeconomic parameters collected at baseline and 4 hours after administration of corticosteroids. Patients were classified into short and long therapy groups, with interval from first albuterol dose to initiation of administration every 4 hours less than or equal to 12 or >12 hours, respectively. Predictors significant by univariate analysis were examined by multiple logistic regression. Results: Five variables were associated with long therapy (n = 85) versus short therapy (n = 193): previous intensive care unit admission (odds ratio [OR] 7.2, 95% Cl = 1.85, 27.7); baseline oxygen saturation less than or equal to 92% (OR 2.6, 95% Cl = 0.89, 7.4), asthma score greater than or equal to6/9 (OR 2.9, 95% Cl = 1.9, 4.37), oxygen saturation less than or equal to 92% (OR 6.6, 95% Cl = 1.34, 32.0), and hourly albuterol dosing interval (OR 4.3, 95% Cl = 0.82, 22.12) 4 hours after administration of corticosteroids. Probability of long therapy was 91.8% to 99% for greater than or equal to3 predictors, but only 40.6% to 61.8% for individual factors. Conclusion: A combination of 3 or more factors predicts long bronchodilator therapy and signals the need for hospitalization. Children with only one predictor can be safely treated in the emergency department or observation unit and reevaluated.