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The asthma prediction rule to decrease hospitalizations for children with asthma

Arnold, Donald H.; Sills, Marion R.; Walsh, Colin G.

Current Opinion in Allergy and Clinical Immunology: June 2016 - Volume 16 - Issue 3 - p 201–209
doi: 10.1097/ACI.0000000000000259
OUTCOME MEASURES: Edited by Henry Milgrom and René Maximiliano Gómez
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Purpose of review The aim of the present review was to discuss the challenges around clinical decision-making for hospitalization of children with acute asthma exacerbations and the development, internal validation, and future potential of the asthma prediction rule (APR) to provide meaningful clinical decision-support that might decrease unnecessary hospitalizations.

Recent findings The APR was developed and internally validated using predictor variables available before treatment in the emergency department, and performed well to predict ‘need-for-hospitalization.’ Oxygen saturation on room air and expiratory phase prolongation were most strongly associated with need-for-hospitalization.

Summary Research on prediction rules in pediatric asthma is rare. We developed and internally validated the APR using clinically intuitive predictor variables that are available at the bedside. Before incorporation into electronic decision-support the APR must undergo external validation and an impact analysis to determine if use of this tool will change clinician behavior and improve patient outcomes.

aDivision of Emergency Medicine, Department of Pediatrics and Center for Asthma Research, Vanderbilt University School of Medicine, Nashville, Tennessee

bSection of Emergency Medicine, Department of Pediatrics, University of Colorado School of Medicine, Aurora, Colorado

cDepartment of Biomedical Informatics, Vanderbilt University School of Medicine, Nashville, Tennessee, USA

Correspondence to Donald H. Arnold, MD, MPH, Room 1348A, Division of Emergency Medicine, Vanderbilt Children's Hospital, Nashville, TN 37232-9001, USA. Tel: +1 615 936 4498; fax: +1 615 507 1943; e-mail: don.arnold@vanderbilt.edu

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