Clinical scores for acute asthma in pre-school children. A review of the literature

Development of a clinical asthma score for use in hospitalized children between 1 and 5 years of age

The objective of this study was to develop a clinical asthma score (CAS) for use in hospitalized children between 1 and 5 years of age. Formal approaches to item selection and reduction, reliability, discriminatory power, validity, and responsiveness were used. The final CAS consisted of five clinical characteristics: respiratory rate, wheezing, indrawing, observed dyspnea, and inspiratory-to-expiratory ratio. Interrater reliability was high (weighted kappa = 0.82), and the CAS was discriminatory (Ferguson's delta = 0.92). The CAS was valid, with a strong correlation with length of hospital stay (Spearman's correlation = 0.47, p < 0.05) and drug dosing interval (Spearman's correlation = -0.58, p < 0.01). The CAS was responsive, with a significant change in CAS from admission to discharge (Wilcoxon signed rank test, p < 0.01). This score, for use in hospitalized preschool children, is reliable, discriminatory, valid, and responsive.

Evaluation of an asthma severity score

OBJECTIVE

To evaluate inter-observer agreement and validity of an asthma severity score derived from wheeze, heart rate and accessory muscle use components.

METHODOLOGY

Children with acute asthma were examined independently and simultaneously by two observers, followed by pulse oximetry and spirometry in those over 5 years with repeatable measurements.

RESULTS

Inter-observer agreement was very good (weighted kappa 0.82, 95% confidence interval 0.63 to 1.00), the component with the best agreement being the accessory muscle score (0.76, 0.57 to 0.95). The score correlated significantly with oxygen saturation, heart rate, and forced expiratory volume in 1 s (FEV1). In a multivariate model, FEV1 was best related to accessory muscle use.

CONCLUSIONS

The asthma severity score has very good inter-observer agreement with a moderate relationship to oxygenation and FEV1.