Prospective evaluation of two clinical scores for acute asthma in children 18 months to 7 years of age

Serge Gouin, Isabelle Robidas, Jocelyn Gravel, Chantal Guimont, Dominic Chalut, Devendra Amre

Research output: Contribution to journalArticle

Abstract

Objectives: The objective was to evaluate the discriminatory ability of two clinical asthma scores, the Preschool Respiratory Assessment Measure (PRAM) and the Pediatric Asthma Severity Score (PASS), during an asthma exacerbation. Methods: This was a prospective cohort study in an academic pediatric emergency department (ED; 60,000 visits / year) conducted from March 2006 to October 2007. All patients 18 months to 7 years of age who presented for an asthma exacerbation were eligible. The primary outcome was a length of stay (LOS) of >6 hours in the ED or admission to the hospital. Clinical findings and components of the PRAM and the PASS were assessed by a respiratory therapist (RT) at the start of the ED visit and after 90 minutes of treatment. Results: During the study period, 3,845 patients were seen in the ED for an asthma exacerbation. Of these, 291 were approached to participate, and eight refused. Moderate levels of discrimination were found between a LOS of >6 hours and / or admission and PRAM (area under the receiver-operating characteristic curve [AUC] = 0.69, 95% confidence interval [CI] = 0.59 to 0.79) and PASS (AUC = 0.70, 95% CI = 0.60 to 0.80) as calculated at the start of the ED visit. Significant similar correlations were seen between the physician's judgment of severity and PRAM (r = 0.54, 95% CI = 0.42 to 0.65) and PASS (r = 0.55, 95% CI = 0.43 to 0.65). Conclusions: The PRAM and PASS clinical asthma scores appear to be measures of asthma severity in children with discriminative properties.

Original languageEnglish (US)
Pages (from-to)598-603
Number of pages6
JournalAcademic Emergency Medicine
Volume17
Issue number6
DOIs
StatePublished - 2010
Externally publishedYes

Fingerprint

Asthma
Pediatrics
Confidence Intervals
Area Under Curve
Length of Stay
Aptitude
ROC Curve
Hospital Emergency Service
Cohort Studies
Prospective Studies
Physicians

Keywords

  • Asthma
  • Clinical scores
  • Emergency medicine

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Prospective evaluation of two clinical scores for acute asthma in children 18 months to 7 years of age. / Gouin, Serge; Robidas, Isabelle; Gravel, Jocelyn; Guimont, Chantal; Chalut, Dominic; Amre, Devendra.

In: Academic Emergency Medicine, Vol. 17, No. 6, 2010, p. 598-603.

Research output: Contribution to journalArticle

Gouin, Serge ; Robidas, Isabelle ; Gravel, Jocelyn ; Guimont, Chantal ; Chalut, Dominic ; Amre, Devendra. / Prospective evaluation of two clinical scores for acute asthma in children 18 months to 7 years of age. In: Academic Emergency Medicine. 2010 ; Vol. 17, No. 6. pp. 598-603.
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abstract = "Objectives: The objective was to evaluate the discriminatory ability of two clinical asthma scores, the Preschool Respiratory Assessment Measure (PRAM) and the Pediatric Asthma Severity Score (PASS), during an asthma exacerbation. Methods: This was a prospective cohort study in an academic pediatric emergency department (ED; 60,000 visits / year) conducted from March 2006 to October 2007. All patients 18 months to 7 years of age who presented for an asthma exacerbation were eligible. The primary outcome was a length of stay (LOS) of >6 hours in the ED or admission to the hospital. Clinical findings and components of the PRAM and the PASS were assessed by a respiratory therapist (RT) at the start of the ED visit and after 90 minutes of treatment. Results: During the study period, 3,845 patients were seen in the ED for an asthma exacerbation. Of these, 291 were approached to participate, and eight refused. Moderate levels of discrimination were found between a LOS of >6 hours and / or admission and PRAM (area under the receiver-operating characteristic curve [AUC] = 0.69, 95{\%} confidence interval [CI] = 0.59 to 0.79) and PASS (AUC = 0.70, 95{\%} CI = 0.60 to 0.80) as calculated at the start of the ED visit. Significant similar correlations were seen between the physician's judgment of severity and PRAM (r = 0.54, 95{\%} CI = 0.42 to 0.65) and PASS (r = 0.55, 95{\%} CI = 0.43 to 0.65). Conclusions: The PRAM and PASS clinical asthma scores appear to be measures of asthma severity in children with discriminative properties.",
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