{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T15:07:41Z","timestamp":1789571261205,"version":"build-2803163510"},"reference-count":27,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T00:00:00Z","timestamp":1722211200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T00:00:00Z","timestamp":1722211200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Pediatric Pulmonology"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Rationale<\/jats:title>\n                    <jats:p>More targeted management of severe acute pediatric asthma could improve clinical outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To identify distinct clinical phenotypes of severe acute pediatric asthma using variables obtained in the first 12 h of hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study in a quaternary care children's hospital from 2014 to 2022. Encounters for children ages 2\u201318 years admitted to the hospital for asthma were included. We used consensus k means clustering with patient demographics, vital signs, diagnostics, and laboratory data obtained in the first 12 h of hospitalization.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements and Main Results<\/jats:title>\n                    <jats:p>\n                      The study population included 683 encounters divided into derivation (80%) and validation (20%) sets, and two distinct clusters were identified. Compared to Cluster 1 in the derivation set, Cluster 2 encounters (177 [32%]) were older (11 years [8; 14] vs. 5 years [3; 8];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01) and more commonly males (63% vs. 53%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.03) of Black race (51% vs. 40%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u2009.03) with non\u2010Hispanic ethnicity (96% vs. 84%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01). Cluster 2 encounters had smaller improvements in vital signs at 12\u2010h including percent change in heart rate (\u22121.7 [\u221211.7; 12.7] vs. \u22127.8 [\u221218.5; 1.7];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01), and respiratory rate (0.0 [\u221220.0; 22.2] vs. \u221211.4 [\u221227.3; 9.0];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01). Encounters in Cluster 2 had lower percentages of neutrophils (70.0 [55.0; 83.0] vs. 85.0 [77.0; 90.0];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01) and higher percentages of lymphocytes (17.0 [8.0; 32.0] vs. 9.0 [5.3; 14.0];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01). Cluster 2 encounters had higher rates of invasive mechanical ventilation (23% vs. 5%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01), longer hospital length of stay (4.5 [2.6; 8.8] vs. 2.9 [2.0; 4.3];\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01), and a higher mortality rate (7.3% vs. 0.0%;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u2009.01). The predicted cluster assignments in the validation set shared the same ratio (~2:1), and many of the same characteristics.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We identified two clinical phenotypes of severe acute pediatric asthma which exhibited distinct clinical features and outcomes.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/ppul.27197","type":"journal-article","created":{"date-parts":[[2024,7,29]],"date-time":"2024-07-29T10:46:04Z","timestamp":1722249964000},"page":"3313-3321","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Identification of severe acute pediatric asthma phenotypes using unsupervised machine learning"],"prefix":"10.1002","volume":"59","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5251-2399","authenticated-orcid":false,"given":"Colin","family":"Rogerson","sequence":"first","affiliation":[{"name":"Department of Pediatrics Indiana University School of Medicine Indianapolis Indiana USA"},{"name":"Regenstrief Institute Center for Biomedical Informatics Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Nelson Sanchez\u2010Pinto","sequence":"additional","affiliation":[{"name":"Anne &amp; Robert H. Lurie Children's Hospital of Chicago Northwestern University Chicago Illinois USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8794-1062","authenticated-orcid":false,"given":"Benjamin","family":"Gaston","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Indiana University School of Medicine Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sarah","family":"Wiehe","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Indiana University School of Medicine Indianapolis Indiana USA"},{"name":"Regenstrief Institute Center for Health Services Research Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Titus","family":"Schleyer","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Indiana University School of Medicine Indianapolis Indiana USA"},{"name":"Regenstrief Institute Center for Biomedical Informatics Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wanzhu","family":"Tu","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Indiana University Indianapolis Indiana USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eneida","family":"Mendonca","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Indiana University School of Medicine Indianapolis Indiana USA"},{"name":"Cincinnati Children's Hospital and Medical Center Cincinnati Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2024,7,29]]},"reference":[{"key":"e_1_2_9_2_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000003347"},{"key":"e_1_2_9_3_1","doi-asserted-by":"publisher","DOI":"10.2500\/aap.2012.33.3547"},{"key":"e_1_2_9_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccc.2012.12.001"},{"key":"e_1_2_9_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2021.1494"},{"key":"e_1_2_9_6_1","doi-asserted-by":"publisher","DOI":"10.1513\/AnnalsATS.202309-807OC"},{"key":"e_1_2_9_7_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.11502"},{"key":"e_1_2_9_8_1","doi-asserted-by":"publisher","DOI":"10.1164\/rccm.200906-0896OC"},{"key":"e_1_2_9_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ccm.2018.10.016"},{"key":"e_1_2_9_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.prrv.2019.08.002"},{"key":"e_1_2_9_11_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12016-018-8712-1"},{"key":"e_1_2_9_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaip.2019.11.008"},{"key":"e_1_2_9_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(07)61602-X"},{"key":"e_1_2_9_14_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.g7594"},{"key":"e_1_2_9_15_1","doi-asserted-by":"publisher","DOI":"10.5409\/wjcp.v6.i1.34"},{"key":"e_1_2_9_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598-019-49539-6"},{"key":"e_1_2_9_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/PCC.0000000000002869"},{"key":"e_1_2_9_18_1","doi-asserted-by":"publisher","DOI":"10.1080\/02770903.2019.1590588"},{"key":"e_1_2_9_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.acap.2016.11.011"},{"key":"e_1_2_9_20_1","doi-asserted-by":"publisher","DOI":"10.1155\/2021\/4553832"},{"key":"e_1_2_9_21_1","unstructured":"R: A Language and Environment for Statistical Computing. 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