Validation of Ramathibodi's acute asthma predictive score.
BACKGROUND
The authors have recently developed Ramathibodi's acute asthma predictive score to help the attending physician decide on a safe discharge of an acute asthmatic patient from the emergency room (ER). However the authors did not validate it in the previous study.


OBJECTIVE
To validate the predictive score with a new different population.


METHODS
The authors conducted a study on acute asthmatic patients, in continuation from our previous study, between September 2005 and September 2007 in the ER of Ramathibodi Hospital. Vital signs, oxygen saturation, and severity factors were recorded. All patients were treated with nebulized salbutamol initially and repeatedly if the peak expiratory flow rates were < 70% predicted or if unfavorable physical signs were seen. The patients who had any of the severity factors were given systemic steroids. Patients were assessed for admission if further treatments were needed after the fourth nebulization. An unfavorable outcome was defined as either hospital admission or relapse within 48 hours of the ER discharge. Then, the authors' predictive score was calculated to give a total score for each patient. Using a cutoff score of 2, the authors calculated sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). The area under the receiver operating characteristic (ROC) curve (AUC) was also calculated and compared with that of the development cohort.


RESULTS
There were 863 visits from 546 patients and 66.6% had a score of < or = 1 while 33.4% had a score of > or = 2. Using a cutoff score of 2, the acute asthma score exhibited a sensitivity of 60.0%, a specificity of 67.4%, a PPV of 5.7%, and a NPV of 98.1%. The validation group's AUC did not differ from that of the development group.


CONCLUSIONS
Ramathibodi's acute asthma predictive score was found as a valid useful tool for a proper ER discharge of acute asthmatic patients.
Boonsarngsuk
Viboon
V
Division of Pulmonary and Critical Care Medicine, Department of Medicine, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand. bss-vb@hotmail.com
Pipopchaiyasit
Nattha
N
Kiatboonsri
Sumalee
S
D000208:Acute Disease; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000420:Albuterol / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D012720:Severity of Illness Index
D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D000420:Albuterol