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Make an M-PACT on asthma: rapid identification of persistent asthma symptoms in a pediatric emergency department

Esther Maria Sampayo1, Amber Chew, Joseph J Zorc

  • 1Division of Emergency Medicine, The Children's Hospital of Philadelphia, Philadelphia, PA 19104-4399, USA. sampayo@email.chop.edu

Pediatric Emergency Care
|January 1, 2010
PubMed

Insights

A brief, 3-item screen effectively identifies persistent asthma symptoms in children treated in emergency departments (EDs). Most children screened continue to experience symptoms and reduced quality of life one month post-visit, indicating a need for further interventions.

Area of Science:

  • Pediatric Emergency Medicine
  • Respiratory Medicine
  • Clinical Assessment Tools

Background:

  • Persistent asthma symptoms are a significant concern in children following emergency department (ED) visits.
  • Accurate and brief assessment tools are needed to identify these children for appropriate management.
  • Current assessment methods may be lengthy or less sensitive in a fast-paced ED setting.

Purpose of the Study:

  • To develop and validate a concise assessment instrument for identifying persistent asthma symptoms in pediatric ED patients.
  • To evaluate the sensitivity and predictive value of a brief screen compared to a longer instrument.
  • To assess the persistence of symptoms and impact on quality of life one month after ED discharge.

Main Methods:

  • A 6-item symptom screen was developed based on national guidelines.
  • Parents of children (1-18 years) discharged after acute asthma treatment completed the screen.
  • A follow-up phone call 4 weeks later repeated the screen and administered an 8-item asthma-related quality-of-life (ARQOL) instrument.
  • Item analysis was performed to refine the screen.

Main Results:

  • A 3-item version of the screen, including symptoms with activity, nighttime symptoms, and need for rescue medication, demonstrated 96% sensitivity for detecting persistent symptoms.
  • Sixty-nine percent of participants reported persistent symptoms four weeks post-ED visit.
  • Children with persistent symptoms exhibited significantly lower ARQOL scores at both baseline and follow-up.

Conclusions:

  • A brief, 3-item screen is highly sensitive in identifying persistent asthma symptoms in pediatric ED populations.
  • A majority of children treated for acute asthma in the ED continue to experience persistent symptoms and reduced quality of life one month later.
  • These findings suggest that pediatric ED patients with persistent symptoms may benefit from additional interventions to improve long-term asthma management.
Abstract

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