Initial emergency department vital signs may predict PICU admission in pediatric patients presenting with asthma exacerbation

Abstract

ABSTRACTObjectiveSevere asthma exacerbations account for a large share of asthma morbidity, mortality, and costs. Here, we aim to identify early predictive factors for pediatric intensive care unit (PICU) admission that could help improve outcomes.MethodsWe performed a retrospective observational study of 6,014 emergency department (ED) encounters at a large children’s hospital, including 95 (1.6%) resulting in PICU admission between 10/1/2015 and 8/31/2017 with ICD9/ICD10 codes for “asthma,” “bronchospasm,” or “wheezing”. Vital signs and demographic information were obtained from EHR data and analyzed for each encounter. Predictive factors were identified using adjusted regression models, and our primary outcome was PICU admission.ResultsHigher mean heartrates (HR) and respiratory rates (RR) and lower SpO2 within the first hour of ED presentation were independently associated with PICU admission. Odds of PICU admission increased 63% for each 10-beats/minute higher HR, 97% for each 10-breaths/minute higher RR, and 34% for each 5% lower SpO2. A binary predictive index using 1-hour vitals yielded OR 11.7 (95%CI 7.4-18.3) for PICU admission, area under the receiver operator characteristic curve (AUROC) 0.82 and overall accuracy of 81.5%. Results were essentially unchanged (AUROC 0.84) after adjusting for asthma severity and initial ED management. In combination with a secondary standardized clinical asthma distress score, positive predictive value increased by seven-fold (5.9% to 41%).ConclusionsA predictive index using HR, RR and SpO2 within the first hour of ED presentation accurately predicted PICU admission in this cohort. Automated vital signs trend analysis may help identify vulnerable patients quickly upon presentation.