RESULTS
During the study period, 587 patients were treated for
asthma, and 297 patients with moderate to severe
asthma met the study inclusion criteria (Figure 1).
Tables 1 and 2 outline the included patients’ baseline
characteristics and outcomes and compare them with
patients who were subsequently hospitalized. The median
PRAM score at triage was 7 (moderate; IQR = 5.0 to
8.0). A total of 152 patients (51%) were classified as
severe asthma exacerbation with PRAM ≥ 8 as shown in
Table 1. All patients received salbutamol and systemic
corticosteroids. The median time to receive systemic
corticosteroids was 28 minutes (IQR = 15 to 43 minutes).
Twenty-one patients (7.4%) received magnesium sulfate
as part of asthma management. Thirty-four patients
(11.4%) required hospitalization. The median duration
of admission was 45 hours (IQR = 32.7 to 66.8 hours).
Of those patients who were discharged, the median ED
length of stay was 304 minutes (IQR = 224 to 412 minutes).
Thirty-three patients (11.1%) stayed in the ED for
more than 8 hours and were subsequently discharged
home (Table 2). Patients who required hospital admission
had higher rates of previous hospital and PICU
admissions for asthma compared to the rest of our
cohort (Table 1). Most (85.2%) of the hospitalized
patients received supplemental oxygen at some point
throughout their ED stays, compared to 18.2% of the
overall cohort (Table 2).
PRAM Score and Association With Admission
Out of the initial 297 patients, 195, 197, and 167 patients
completed PRAM measurements at 2, 3, and 4, hours,
respectively (because patients with rapid improvement
to intensive therapy were discharged). PRAM measurements
at 2 and 3 hours were equally the best predictors
of need for hospitalization (Table 3), with AUC of 0.85
(2 hours, 95% confidence interval [CI] = 0.77 to 0.92;