Related Experiment Video
Updated: Mar 12, 2026
Conducting Respiratory Oscillometry in an Outpatient Setting
Published on: April 8, 2022
Direct concurrent comparison of multiple pediatric acute asthma scoring instruments
Michael D Johnson1, Flory L Nkoy1,2, Xiaoming Sheng1
1a Department of Pediatrics , University of Utah School of Medicine , Salt Lake City , UT , USA.
Insights
Comparing asthma severity scoring tools in pediatric emergency departments (EDs) is feasible. Tools showed better hospitalization prediction after treatment, suggesting post-treatment assessment is more reliable for acute asthma management.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Assessment Tools
- Asthma Management
Background:
- Accurate assessment of acute asthma severity in pediatric Emergency Departments (EDs) is crucial for appropriate treatment.
- Existing clinical scoring instruments lack direct comparative data, leading to arbitrary selection.
- This study addresses the need for comparative analysis of these instruments in a real-world clinical setting.
Purpose of the Study:
- To evaluate the feasibility of directly comparing the properties of multiple acute asthma severity scoring instruments within a pediatric ED.
- To assess inter-rater reliability and predictive ability of these instruments.
Main Methods:
- A novel composite data collection form was used to categorize elements of five scoring instruments.
- Clinicians assessed 48 pediatric patients (2-18 years) with acute asthma before and after initial treatment.
- Inter-rater reliability between clinician types and prediction of hospitalization were compared.
Main Results:
- Inter-rater reliability was consistently lower than previously reported values and did not differ between instruments.
- The predictive ability for hospitalization was significantly higher after treatment compared to before treatment (p < 0.05).
- Potential variations in predictive ability among instruments after treatment were observed (p = 0.054).
Conclusions:
- The study successfully demonstrated the feasibility of simultaneously comparing multiple clinical scoring instruments in pediatric ED practice.
- Asthma scoring instruments showed improved predictive power for hospitalization post-treatment.
- Larger studies are needed to definitively identify the optimal instrument and establish meaningful comparisons.
Objective:
Appropriate delivery of Emergency Department (ED) treatment to children with acute asthma requires clinician assessment of acute asthma severity. Various clinical scoring instruments exist to standardize assessment of acute asthma severity in the ED, but their selection remains arbitrary due to few published direct comparisons of their properties. Our objective was to test the feasibility of directly comparing properties of multiple scoring instruments in a pediatric ED.
Methods:
Using a novel approach supported by a composite data collection form, clinicians categorized elements of five scoring instruments before and after initial treatment for 48 patients 2-18 years of age with acute asthma seen at the ED of a tertiary care pediatric hospital ED from August to December 2014. Scoring instruments were compared for inter-rater reliability between clinician types and their ability to predict hospitalization.
Results:
Inter-rater reliability between clinician types was not different between instruments at any point and was lower (weighted kappa range 0.21-0.55) than values reported elsewhere. Predictive ability of most instruments for hospitalization was higher after treatment than before treatment (p < 0.05) and may vary between instruments after treatment (p = 0.054).
Conclusions:
We demonstrate the feasibility of comparing multiple clinical scoring instruments simultaneously in ED clinical practice. Scoring instruments had higher predictive ability for hospitalization after treatment than before treatment and may differ in their predictive ability after initial treatment. Definitive conclusions about the best instrument or meaningful comparison between instruments will require a study with a larger sample size.
Related Concept Videos
01:30Asthma-IV: Diagnostic and Management
Clinical Assessment for Asthma:
This is the first step in diagnosing and managing asthma. It includes:
01:24Asthma-III: Symptoms and Complications
Classification of Asthma
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like...
01:26Asthma-II: Pathophysiology and Classification
Additionally, environmental and genetic factors play crucial roles in determining an individual's susceptibility to asthma and the severity of their condition.
Critical processes in asthma pathophysiology include:
01:29Asthma-I: Introduction
01:23Inhaled Medications