Prediction of unsuccessful treatment in patients with severe acute asthma

Goodacre, Steve; Bradburn, Mike; Cohen, Judith; Gray, Alasdair; Benger, Jonathan; Coats, Tim

Abstract

Background: Clinical assessment can be used to identify which patients with acute asthma are at risk of unsuccessful initial treatment. Objective: To determine which elements of clinical assessment predict unsuccessful treatment, defined as needing critical care or any unplanned additional treatment. Methods: We analysed data from a large multicentre trial (the 3Mg trial). Adults with severe acute asthma underwent standardised clinical assessment, including peak expiratory flow rate (PEFR), up to 2 h after initiation of treatment. Standard care was provided other than blinded random allocation to trial treatment or placebo. Patients were followed up by record review up to 30 days. Unsuccessful treatment was defined as needing (1) critical care or (2) critical care or any unplanned additional treatment within 7 days of presentation. Logistic regression was used to identify predictors and derive a prediction model for each outcome. Results: Out of 1084 patients analysed, 81 (7%) received critical care and 157 (14%) received critical care or unplanned additional treatment. Baseline PEFR (p=0.017), baseline heart rate ( p

• Journal Article Type: Article
• Publication Date: Aug 29, 2013
• Journal: Emergency Medicine Journal
• Print ISSN: 1472-0205
• Electronic ISSN: 1472-0213
• Publisher: BMJ Publishing Group
• Peer Reviewed: Peer Reviewed
• Volume: 31
• Issue: e1
• Pages: e40-e45
• DOI: https://doi.org/10.1136/emermed-2013-203046
• Keywords: prediction, unsuccessful treatment, patients, severe acute asthma
• Public URL: https://uwe-repository.worktribe.com/output/824395
• Publisher URL: http://dx.doi.org/10.1136/emermed-2013-203046