Digital marker could enhance accuracy of pediatric asthma risk prediction

Researchers at the Indiana University School of Medicine have developed a more accurate and cost-effective method to predict asthma diagnoses in children by using readily available electronic health records. This scalable approach could enhance early detection rates and help reduce the risk of asthma disease progression in young patients.

In a study recently published in eClinicalMedicine, the researchers enhanced an existing tool, the Pediatric Asthma Risk Score, by adapting it to use electronic health record data to create a new passive digital marker - calculated based on a combination of routinely collected medical history data - for childhood asthma risk. The study was led by Arthur Owora, PhD, associate professor of pediatrics at the IU School of Medicine and research scientist at Regenstrief Institute.

Our hope is that using the childhood asthma passive digital marker in clinical practice will improve the early detection of asthma risk in high-risk children, allowing for earlier interventions that could improve asthma control and lessen the future risk of hospitalization. Ultimately, we plan to study whether early interventions could help prevent the disease from progressing to more severe forms, which are often associated with higher health care needs and costs. This would be a win-win scenario for at-risk children, their parents, primary care physicians, and the health care system as a whole."

Arthur Owora, PhD, associate professor of pediatrics at the IU School of Medicine

For this study, Owora collaborated with IU School of Medicine's Benjamin Gaston, MD, vice chair of translational research and the Billie Lou Wood Professor of Pediatrics, and Malaz Boustani, MD, the Richard M. Fairbanks Professor of Aging Research and director of the Center for Health Innovation and Implementation Science.

"This passive digital marker is very scalable because it requires zero additional minutes from the clinical team by using the already captured data in the electronic health record," Boustani said. "Scalable innovations like this in pediatrics have unbelievable public health impact for the health of the future generation of Americans."

The findings revealed the new passive digital marker was more accurate than the traditional Pediatric Asthma Risk Score in predicting which children would later be diagnosed with asthma between the ages of 4 and 11. The researchers analyzed records of nearly 70,000 children born between 2010 and 2017 using Indiana Network of Patient Care databases.

Owora noted that while clinicians are already effective at assessing asthma risk, the process can be enhanced by efficiently summarizing a patient's medical history to generate earlier, more accurate predictions when and where patients receive medical care. Delays in diagnosis can postpone important preventive measures, such as avoidance of asthma triggers like allergens, initiation of asthma controller medications, provision of asthma education, or other personalized interventions and treatments.

Next, the research team plans to use a randomized clinical trial to evaluate the effectiveness of the childhood asthma passive digital marker in increasing the rate of early childhood asthma diagnoses among high-risk children. The trial will also examine whether the passive digital marker reduces the time between when a child meets criteria for an asthma diagnosis and when a formal asthma diagnosis is made. 

"If the trial is successful, we will explore scaling up the implementation to ensure the benefits of early detection are realized at the state and hopefully at the national level as well," Owora said.

Additional IU study authors include Bowen Jiang and Yash Shah. Owora also collaborated on related research with Robert Tepper, MD, PhD, professor of pediatrics; Nadia Krupp, MD, associate professor of clinical pediatrics; and Kirsten Kloepfer, MD, associate professor of pediatrics.

This research was supported by funding from the National Institutes of Health.