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Acute Bronchial Asthma Index of Fischl et al to Predict Relapse and Need for Hospitalization

Purpose: To predict the likelihood of relapse in patients with acute bronchial asthma and/or the need for hospitalization.

Description

Patients with acute bronchial asthma often can be managed as an outpatient. However, it is important to identify those with more severe disease, as these patients are more likely to relapse (require additional emergency care for asthmatic symptoms) or to require hospitalization for management.


Scoring:  Patient evaluation is performed prior to initial therapy.

 

Parameter

Finding

Points

pulse rate, in beats per minute

< 120

0

 

>= 120

1

respiratory rate in breaths per minute

< 30

0

 

>= 30

1

pulsus paradoxicus in mm Hg

< 18

0

 

>= 18

1

peak expiratory flow rate in liters per minute

> 120

0

 

<= 120

1

dyspnea

absent to mild

0

 

moderate to severe

1

accessory muscle use

absent to mild

0

 

moderate to severe

1

wheezing

absent to mild

0

 

moderate to severe

1

 

where:

• pulsus paradoxicus = (systolic blood pressure during inspiration) - (systolic blood pressure during expiration)

• Peak expiratory flow rate is the maximum of 3 replicate determinations with a peak flow meter.

• Accessory muscle use is defined as the visible retraction of the sternocleidomastoid muscles.

 

predictor index score =

= SUM (points for each of the 7 factors)

 

Interpretation:

• minimum score 0

• maximum score 7

• An index >= 4 was 95% accurate in predicting risk of relapse and 96% accurate in predicting the need for hospitalization.

 

Performance:

• Rose et al found that, while the index score did correlate with hospitalization, the association was not strong enough to aid in clinical decision making.


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Specialty

Objective

ICD-10