Predicting Admission Risk in Kids With Asthma (PARKA)
Maternal, Child & Mental Health
The PARKA clinical prediction score accurately identifies children at risk for future asthma ED visits. Comprised of only 4 questions with a score ranging from 0-6, this tool is practical for point of care use and has the potential to be adopted in ED’s across Ontario and Canada. Accurate prediction of children at risk for future asthma ED visits would allow ED clinicians to target resource-intensive preventative interventions to this vulnerable group. Such targeted care could improve morbidity at the individual patient level, optimize allocation of resource-intensive health care resources and potentially reduce overall acute health care services use. Given the high volume of asthma ED visits among children, this could yield important cost savings to health care systems allowing resources to be diverted to preventative rather than reactive care.
Importance: Asthma is a leading cause of repeat emergency department (ED) visits and hospitalizations in children, many of which may be prevented if this vulnerable population could be accurately identified.
Objective: We aimed to identify predictors of repeat asthma ED visits among children in Ontario, Canada, within one year after an initial asthma ED discharge, and derive a practical clinical prediction score for application at the point of care. Design: We assembled a nested Ontario cohort from the multi-centre prospective DOORWAY cohort study which enrolled children 1 to 17 years presenting with a moderate to severe asthma exacerbation at one of two pediatric ED’s in Ontario, between 2011-2013. We linked to provincial health administrative data to identify all subsequent ED visits occurring within a year following the index visit. We used multivariable logistic regression, to determine predictors of future asthma ED visits, and used reduced model estimates to derive an easily implementable clinical risk score. Results: 257 children (32% female, median age 3.0 years) were included of whom 58 experienced as least one asthma ED visit during follow up. These were best predicted by 4 factors: reported food allergy (0-2 points; OR 4.2, 95%CI 1.2-14.9), family history of asthma (0-1 point; OR 0.5, 95%CI 0.3-0.9), prior acute asthma medical visits in the previous year (0-1 point; OR 2.8, 95%CI 0.9-8.6), and emergency room visits for any respiratory diagnosis in the previous year (0-2 points; OR 3.0, 95%CI 1.4-6.4). The 6-point PARKA clinical prediction score has an AUC of 0.71 (95%CI 0.64 – 0.78), with the probability of future asthma ED visit ranging from 3.6% – 73.5% for a score of 0-6. Conclusion: The PARKA score predicts the risk of a future asthma ED visit in a cohort of Ontario children asthma ED visits. Following further validation, this tool may aid ED clinicians to accurately target resource-intensive preventative interventions to at-risk children.
Manuscript is in preparation