Pediatric predictive index for hospitalization in acute asthma.

To develop a pediatric predictor index (PPI) for the outcome of emergency management of acute asthma, 156 children were studied prospectively and grouped by outcome. Of 193 episodes, 130 (67.4%) resulted in successful treatment, 39 (20.2%) in relapse, and 24 (12.4%) in admission. Measured and observed variables from before and after initial therapy were analyzed for the three groups. There were no significant differences between the relapse and successful treatment groups, which were combined for analysis and termed the discharge group. Significant differences were noted between the admission and discharge groups only for dyspnea before and after therapy, accessory muscle use, inspiratory breath sounds and wheezing, and post-respiratory rates, but not for pulse or peak expiratory flow rates before or after therapy. The PPI was determined with multivariate logistic regression and is calculated using the following variables: inspiratory breath sounds, wheezing, and respiratory rates. A score of 0 correctly categorized 95% of admissions, but incorrectly categorized 34% of those discharged. Despite low specificity and limited usefulness as early predictors of admission, PPI variables may serve as valuable adjuncts to the physician in determining the outcome of acute asthma in children.