title: Predicting hospitalization in children with acute asthma.
abstract: BACKGROUND
  Acute asthma is one of the most common medical emergencies in children. Appropriate assessment/treatment and early identification of factors that predict hospitalization are critical for the effective utilization of emergency services.
  
  
  OBJECTIVE
  To identify risk factors that predict hospitalization and to compare the concordance of the Modified Pulmonary Index Score (MPIS) with the Global Initiative for Asthma (GINA) guideline criteria in terms of attack severity.
  
  
  METHODS
  The study population was composed of children aged 5-18 years who presented to the Emergency Departments (ED) of the tertiary reference centers of the country within a period of 3 months. Patients were evaluated at the initial presentation and the 1(st) and 4(th) hours.
  
  
  RESULTS
  Of the 304 patients (median age: 8.0 years [interquartile range: 6.5-9.7]), 51.3% and 19.4% required oral corticosteroids (OCS) and hospitalization, respectively. Attack severity and MPIS were found as predicting factors for hospitalization, but none of the demographic characteristics collected predicted OCS use or hospitalization. Hospitalization status at the 1(st) hour with moderate/severe attack severity showed a sensitivity of 44.1%, specificity of 82.9%, positive predictive value of 38.2%, and negative predictive value of 86.0%; for MPIS ≥ 5, these values were 42.4%, 85.3%, 41.0%, and 86.0%, respectively. Concordance in prediction of hospitalization between the MPIS and the GINA guideline was found to be moderate at the 1(st) hour (κ = 0.577).
  
  
  CONCLUSIONS
  Attack severity is a predictive factor for hospitalization in children with acute asthma. Determining attack severity with MPIS and a cut-off value ≥ 5 at the 1(st) hour may help physicians in EDs. Having fewer variables and the ability to calculate a numeric value with MPIS makes it an easy and useful tool in clinical practice.
authors: Pediatric Allergy and Asthma Unit, Hacettepe University Faculty of Medicine, Ankara, Turkey.
authors: A Betul
authors: AB
authors: Buyuktiryaki
authors: Ersoy
authors: E
authors: Civelek
authors: Demet
authors: D
authors: Can
authors: Fazıl
authors: F
authors: Orhan
authors: Metin
authors: M
authors: Aydogan
authors: Ismail
authors: I
authors: Reisli
authors: Ozlem
authors: O
authors: Keskin
authors: Ahmet
authors: A
authors: Akcay
authors: Mehtap
authors: M
authors: Yazicioglu
authors: Haluk
authors: H
authors: Cokugras
authors: Hasan
authors: H
authors: Yuksel
authors: Dost
authors: D
authors: Zeyrek
authors: A Kadir
authors: AK
authors: Kocak
authors: Bulent E
authors: BE
authors: Sekerel
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012372:ROC Curve; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D014421:Turkey / Q000453:epidemiology
chemical_list: D005938:Glucocorticoids