Wen-Chieh Yang1,2, Jung Lee3,4, Chun-Yu Chen1,2, Yu-Jun Chang5, Han-Ping Wu3,4. 1. Department of Pediatric Emergency Medicine, Changhua Christian Children's Hospital, Changhua, Taiwan. 2. School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. 3. Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, Taiwan. 4. College of Medicine, Chang Gung University, Taoyuan, Taiwan. 5. Laboratory of Epidemiology and Biostastics, Changhua Christian Hospital, Changhua, Taiwan.
Abstract
BACKGROUND: Westley croup score has been generally used to assess the severity of croup. This study aimed to identify the individual factors associated with Westley score (WS) and other clinical factors in predicting the outcomes in the pediatric emergency department (PED). POPULATION AND METHOD: We prospectively recruited patients with croup from the PED. The individual factors of WS, fever, age, and the length of hospital stay were analyzed to predict clinical outcomes. We calculated all the areas under the receiver operating characteristic (ROC) curve to determine the cutoff values of initial WS discriminating the need for admission to the wards. RESULT: A total of 192 patients with croup were enrolled. Cyanosis and altered consciousness were not clinically significant even in patients with severe croup, whereas retraction and air entry were the major factors in WS for predicting clinical outcomes. The initial WS had a strong correlation with the length of hospital stay (r = 0.617, P < 0.001). ROC analysis showed that patients with an initial WS <2 (sensitivity, 5%; specificity, 100%; LR+ , 1.05; LR- , 0; AUC, 0.87) were discharged home while the patients with an initial WS ≥5 (sensitivity, 99%; specificity, 57%; LR+ , 41.0; LR- , 0.43) were more likely to require to stay in the PED. Patients with an WS ≥6 were more likely to be admitted to the wards (sensitivity, 97%; specificity, 47%; LR+ , 416.35; LR- , 0.54; AUC, 0.90) CONCLUSION: Patients with an initial WS of 1-2 could be safely treated at home and those with initial WS >5 required hospitalization for further treatment.
BACKGROUND: Westley croup score has been generally used to assess the severity of croup. This study aimed to identify the individual factors associated with Westley score (WS) and other clinical factors in predicting the outcomes in the pediatric emergency department (PED). POPULATION AND METHOD: We prospectively recruited patients with croup from the PED. The individual factors of WS, fever, age, and the length of hospital stay were analyzed to predict clinical outcomes. We calculated all the areas under the receiver operating characteristic (ROC) curve to determine the cutoff values of initial WS discriminating the need for admission to the wards. RESULT: A total of 192 patients with croup were enrolled. Cyanosis and altered consciousness were not clinically significant even in patients with severe croup, whereas retraction and air entry were the major factors in WS for predicting clinical outcomes. The initial WS had a strong correlation with the length of hospital stay (r = 0.617, P < 0.001). ROC analysis showed that patients with an initial WS <2 (sensitivity, 5%; specificity, 100%; LR+ , 1.05; LR- , 0; AUC, 0.87) were discharged home while the patients with an initial WS ≥5 (sensitivity, 99%; specificity, 57%; LR+ , 41.0; LR- , 0.43) were more likely to require to stay in the PED. Patients with an WS ≥6 were more likely to be admitted to the wards (sensitivity, 97%; specificity, 47%; LR+ , 416.35; LR- , 0.54; AUC, 0.90) CONCLUSION:Patients with an initial WS of 1-2 could be safely treated at home and those with initial WS >5 required hospitalization for further treatment.
Authors: Amit Sah; Valerie F Civelli; Christina Donath; Lulua Mandviwala; Arash Heidari Journal: J Investig Med High Impact Case Rep Date: 2022 Jan-Dec