Use of the emergency department observation unit in the treatment of acute asthma

Ann Emerg Med. 1982 Feb;11(2):77-83. doi: 10.1016/s0196-0644(82)80301-6.


Because asthmatics have the highest utilization rate (11%) kin our emergency department (ED) observation unit (OU), we conducted a study correlating predictors of the need for OU therapy to initial disposition (ID) and final disposition (FD) using chart audit of treated asthmatics. Twenty-four clinical variables. (historical, physiological, laboratory, therapy response) were examined utilizing chi-square and Student's t tests. Forty-six asthmatics were treated during a four-month period in 1980. The ID breakdown was as follows: 1) home, 17; 2) OU, 23; and 3) admit, 6. Twenty-seven (59%) of the patients received treatment in the OU at some point in their attack (initial or rebound); 18 (39%) were definitively treated in the ED, and nine (20%) were admitted. The mean OU stay was 19 hours at a cost that was 34% of that incurred for a hospital admission. The FD differed from the ID in 14 of 46 (30%): 1) home, 12; 2) holding, observation, and short-term therapy, 18; and 3) admit, 16. Clinical variables correlating significantly with definitive therapy based on ID and FD were historical; symptoms greater than 24 hours, prior OU admissions, and prior hospitalizations. We conclude that the OU is appropriate, safe, and less expensive than admission; is not used for procrastination in decision making and decreases the hospitalization rate. Historical data correlated significantly with both ID and FD, while clinical variables were of little predictive value.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Acute Disease
  • Adolescent
  • Adult
  • Aged
  • Asthma / therapy*
  • Costs and Cost Analysis
  • Emergency Service, Hospital* / economics
  • Female
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Outcome and Process Assessment, Health Care
  • Retrospective Studies