A risk screening questionnaire for adult asthmatics to predict attendance at hospital emergency departments

Abstract

Study objectives: To develop a practical screening tool that could identify adult patients highly likely to attend a hospital emergency department (ED) in a 1-year period. Design: Retrospective case-control study of patients who did and did not attend a hospital ED for asthma in the past year. Setting: Adelaide, South Australia. Participants: One hundred sixty- five adults attending an ED for asthma were compared with 260 adults with asthma from a community survey who had not attended an ED in the previous year. Measurements and results: The following variables were independently related to ED attendance: having been woken from sleep by asthma in past month; having been admitted to hospital because of asthma in the past year; having seen more than one general practitioner for asthma in the last 12 months; a moderate or severe self-rating of asthma in the last month; and having taken oral steroid medication for asthma in past month. A risk screening questionnaire using the weighted responses to these five variables with a cutoff score of 30/100 demonstrated a sensitivity of 90% and specificity of 88%. Conclusions: These findings agree with those of previous studies that markers of asthma severity and discontinuity of care are risk factors for adverse asthma outcomes. Validation of the risk screening questionnaire is required in a prospective study.