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Asthma Exacerbation Study

Asthma is the most common chronic disease in children (10% of Canadian population) and asthma exacerbations are one of the most common medical reasons for children to be brought to the ED. At CHEO there are around 2400 ED such visits per year, resulting in 6-7 asthma-related visits daily.

A photograph showing the triage desk at CHEO

Practice guidelines define three categories of exacerbation severity: mild, moderate, and severe. The assignment of a patient to one of these categories implies a specific ED management path. Patients with a mild exacerbation are usually discharged home following a brief course of treatment (about 4 hours), patients with a moderate exacerbation undergo prolonged treatment and observation in the ED or in an observation unit (between 4 and 16 hours), and patients with a severe exacerbation receive maximal stabilizing therapy before being transferred to an in-patient bed for ongoing treatment (after about 16 hours in the ED).

It is important that the severity of the child’s asthma exacerbation is determined as soon as possible, so that appropriate therapies are prescribed and provided in a timely fashion. Underestimation of the exacerbation severity results in inadequate treatment, premature discharge and a possible return visit, while overestimation results in patients unnecessarily occupying beds and nursing time when they could be safely managed at home. Ideally, an assessment decision on the severity of the exacerbation should be made at the patient’s presentation to the ED when the management process starts.

Considering a requirement for an early assessment of asthma severity (around 2h after initial nursing triage), we concluded that there is an opportunity for a clinical DSS that would help physicians in evaluation of patients with asthma at the beginning of the management process. This functionality will be a component of newly developed MET3 Support multi-agent system.

In order to collect reliable data for developing the clinical model for predicting severity of asthma exacerbation we have designed a prospective study to take place at CHEO. The study started in late 2006 and will finish in summer 2007. It includes all ED patients who present with asthma exacerbations who agree to participate and who satisfy inclusion and exclusion criteria approved by the CHEO Ethics Board. So far, records for over 400 visits have been collected.

Study design asks for the collection of patient information at multiple assessment points during a patient’s visit to the ED by multiple healthcare personnel. The first round of patient data including clinical signs is collected during the triage assessment by a triage nurse. The second assessment is carried out by EP, who collects information on the patient’s medical history and reassesses clinical signs. The third assessment, similarly to the triage assessment, includes clinical signs and may be carried out by either a nurse or EP. This assessment is conducted at approximately the 2 hours after triage, depending on ED workload and patient’s condition.

Collected data will be analyzed using variety of data mining methodologies and resulting clinical DSS will be evaluated for its prospective performance

Workflow for collecting patient information