Assessment of clinical judgment accuracy provided by emergency physicians in comparison with Peak Flowmetry in the severity and discharge criteria of patients with asthma attack

Abstract

Introduction: In the emergency department, the decisions on admission or discharge are based on clinical symptoms and physical examinations. The aim of this study is to compare the assessment of emergency physician clinical judgment accuracy with the actual amount of peak expiratory flow rate (PEFR).

Method: The present research was a cross-sectional study. In this study, 138 patients with asthma of the age of 18 to 55 years were enrolled. From admission to discharge, clinical signs and symptoms were investigated and recorded by emergency physicians and the severity of asthma was determined (mild, moderate, severe). In both stages (admission and discharge), the PEFR was measured by researcher and was compared with the severity of asthma, which are determined based on clinical symptoms and physical examination.

Results: 37.7% of patients were male and the rest were females, and the mean age of participants was 49.84 years. The number of mild, moderate and severe asthma cases was 14, 36 and 88, respectively in peak flow meter. The number of mild, moderate and severe asthma cases was 37, 32 and 69, respectively in clinical judgment. In assessment of emergency physician clinical judgment accuracy in severity of asthma in comparison with peak flowmetry, the result was the kappa value of 0.231 (P <0.001).

Conclusion: The study showed that clinical judgment of physicians in the emergency department is not a good prediction of severity of asthma.