• Michael D Witting, Rami B Yanes, Ryan M Thompson, Dan Lemkin, and DezmanZachary D WZDWDepartment of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland..
• Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland.
• J Emerg Med. 2022 Mar 1; 62 (3): 283-290.

BackgroundEmergency physicians must choose whether patients with asthma are admitted to a hospital ward or a higher level of care, such as an intermediate care unit (IMC) or intensive care unit (ICU).ObjectiveThis study aimed to determine which variables, available early during emergency department (ED) visits, are associated with IMC/ICU admission.MethodsIn this retrospective chart review (records from 2015-2018), two trained abstractors, blinded to study hypothesis, abstracted data on predictor variables and disposition (ward vs. IMC/ICU). Predictor variables were defined explicitly and abstracted from the periods of ED arrival and after treatment with 7.5 mg nebulized albuterol. Distress was defined as tripod positioning or speaking in broken sentences. "Arrival" and "after treatment" scoring systems were derived based on adjusted odds ratios (aOR) for predictor variables. We performed analyses using SASⓇ, version 9.4 (SAS Institute).ResultsAmong 273 patients, 105 required admission to an IMC/ICU. At presentation, distress (aOR 2.1, 95% confidence interval [CI] 1.1-3.9), room air SpO2 ≥95% (aOR 0.29, 95% CI 0.14-0.62), respiratory rate > 20 breaths/min (aOR 1.9, 95% CI 1.0-3.3), and retractions (aOR 1.9, 95% CI 1.1-3.3) were associated with IMC/ICU admission. After initial bronchodilator therapy, heart rate > 120 beats/min (aOR 7.1, 95% CI 2.0-25), room air SpO2 ≥ 95% (aOR 0.15, 95% CI 0.07-0.34), and noninvasive ventilation (aOR 6.5, 95% CI 2.5-17) were associated with IMC/ICU admission. Both scoring systems stratified risk of IMC/ICU admission into low-risk (9-10%) and high-risk (70-100%) groups.ConclusionsCombinations of predictor variables, available early in a patient's stay, stratify risk of admission to an IMC/ICU bed.Copyright © 2021 Elsevier Ltd. All rights reserved.

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