Performance of the Asthma Clinical Score in the Evaluation of Acute Asthma in the Emergency Department.

IF 2.7 3区医学 Q1 PEDIATRICS

Pediatric Pulmonology Pub Date : 2025-04-01 DOI:10.1002/ppul.71084

Adjoa A Andoh, Annie Truelove, Sara Helwig, Matthew C Nash, Lisa Ulrich, Richard Shell, Julie C Leonard

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引用次数: 0

Abstract

Objective: The primary objective of this study was to examine the performance of the Asthma Clinical Score (ACS) relative to the Pediatric Respiratory Assessment Measure (PRAM). Our secondary objectives were to determine interrater reliability, discriminative validity, responsiveness, and predictive validity of the ACS and PRAM.

Methods: This was a single-site prospective observational study of children ages 2 to < 18 years presenting to the emergency department (ED) for asthma exacerbations. Clinicians completed paired assessments using ACS and PRAM at three time points of each patients ED stay. Construct validity correlating the performance of the ACS to PRAM, and interrater reliability were analyzed using Spearmen's rank correlation coefficients and Cohen's kappa coefficient, respectively. Cohen's d was calculated to compare the scores of patients who received certain treatments to patients who did not. Reliable change index (RCI) was used to determine the responsiveness of each score. Predictive validity for hospitalization was analyzed using Area Under the Receiver Operating Characteristic curve (AUROCc) and Akaike Information Criterion (AIC).

Results: 399 children were enrolled with 338 paired clinician observations. The ACS and PRAM scores were strongly correlated at all time points (n = 1383, $ρ$ = 0.874). Both the ACS and PRAM showed moderate interrater reliability at all time points (n = 338, κ_w = 0.77 and κ_w = 0.69, respectively). Patients receiving albuterol nebulization or adjunctive medications had higher average ACS and PRAM scores. ACS showed a better ability to detect responsiveness than the PRAM (31% vs 15% respectively). The pretreatment ACS showed comparable predictive validity to the PRAM.

Conclusion: The ACS was highly correlated with PRAM and is a reliable score in this cohort. The ACS showed good discriminative validity, predictive validity and responsiveness. This study supports the ACS as a useful tool in ED assessment of asthma exacerbation severity in children.

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哮喘临床评分在急诊科急性哮喘评估中的应用

目的：本研究的主要目的是检查哮喘临床评分（ACS）相对于儿科呼吸评估量表（PRAM）的表现。我们的次要目的是确定ACS和PRAM的判读信度、判别效度、反应性和预测效度。方法：这是一项针对2至2岁儿童的单点前瞻性观察研究。结果：399名儿童入组，338名配对临床观察。ACS与PRAM评分在各时间点呈显著相关（n = 1383, ρ $\rho $ = 0.874）。ACS和PRAM在所有时间点均表现出中等的互信度（n = 338, κw = 0.77, κw = 0.69）。接受沙丁胺醇雾化或辅助药物治疗的患者平均ACS和PRAM评分较高。ACS检测反应性的能力优于PRAM（分别为31%和15%）。预处理ACS的预测效度与PRAM相当。结论：ACS与PRAM高度相关，在该队列中是可靠的评分。ACS具有良好的判别效度、预测效度和反应性。本研究支持ACS作为ED评估儿童哮喘加重严重程度的有用工具。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pediatric Pulmonology 医学-呼吸系统

CiteScore

6.00

自引率

12.90%

发文量

468

审稿时长

3-8 weeks

期刊介绍： Pediatric Pulmonology (PPUL) is the foremost global journal studying the respiratory system in disease and in health as it develops from intrauterine life though adolescence to adulthood. Combining explicit and informative analysis of clinical as well as basic scientific research, PPUL provides a look at the many facets of respiratory system disorders in infants and children, ranging from pathological anatomy, developmental issues, and pathophysiology to infectious disease, asthma, cystic fibrosis, and airborne toxins. Focused attention is given to the reporting of diagnostic and therapeutic methods for neonates, preschool children, and adolescents, the enduring effects of childhood respiratory diseases, and newly described infectious diseases. PPUL concentrates on subject matters of crucial interest to specialists preparing for the Pediatric Subspecialty Examinations in the United States and other countries. With its attentive coverage and extensive clinical data, this journal is a principle source for pediatricians in practice and in training and a must have for all pediatric pulmonologists.