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Pediatric asthma severity score is associated with critical care interventions
Danielle K Maue1, Nadia Krupp1, Courtney M Rowan1
1Danielle K Maue, Courtney M Rowan, Department of Pediatric Critical Care, Indiana University School of Medicine, Indianapolis, IN 46202, United States.
Insights
The standardized asthma severity scoring system (PASS) effectively predicts longer intensive care stays and continuous albuterol use in pediatric asthma patients. This scoring can aid in resource allocation for severe asthma cases.
Area of Science:
- Pediatric Critical Care Medicine
- Respiratory Medicine
- Clinical Outcomes Research
Background:
- Status asthmaticus is a severe form of asthma requiring intensive care.
- Accurate assessment of asthma severity is crucial for appropriate patient management and resource allocation.
- The Pediatric Asthma Severity Score (PASS) is a tool designed to standardize asthma severity assessment.
Purpose of the Study:
- To evaluate the association between the Pediatric Asthma Severity Score (PASS) and key clinical outcomes in pediatric patients with status asthmaticus.
- To determine if PASS scores correlate with the duration of continuous albuterol administration and length of stay in the pediatric intensive care unit (PICU).
Main Methods:
- A retrospective chart review was conducted at a single children's hospital involving 188 participants aged 2-19 with status asthmaticus.
- The Pediatric Asthma Severity Score (PASS) was calculated upon PICU admission and categorized into mild (≤7), moderate (8-11), and severe (≥12).
- Comparisons were made between severity groups regarding the duration of continuous albuterol treatment and PICU length of stay.
Main Results:
- Patients in the severe PASS group experienced significantly longer durations of continuous albuterol (median 21.5 hours) compared to moderate (15 hours) and mild (10 hours) groups (P=0.001).
- The severe PASS group also had a significantly longer PICU length of stay (median 35.6 hours) than the moderate (26.5 hours) and mild (17.6 hours) groups (P=0.001).
- Age distribution was similar across all severity groups.
Conclusions:
- A higher Pediatric Asthma Severity Score (PASS) is significantly associated with prolonged continuous albuterol use and extended PICU stays in pediatric patients with status asthmaticus.
- The findings suggest that PASS can be a valuable tool for predicting resource needs and guiding disposition decisions for pediatric asthma patients.
- Implementing PASS may facilitate the safe and efficient distribution of asthmatic patients to appropriate levels of care.
Aim:
To determine if a standardized asthma severity scoring system (PASS) was associated with the time spent on continuous albuterol and length of stay in the pediatric intensive care unit (PICU).
Methods:
This is a single center, retrospective chart review study at a major children's hospital in an urban location. To qualify for this study, participants must have been admitted to the PICU with a diagnosis of status asthmaticus. There were a total of 188 participants between the ages of two and nineteen, excluding patients receiving antibiotics for pneumonia. PASS was calculated upon PICU admission. Subjects were put into one of three categories based on PASS: ≤ 7 (mild), 8-11 (moderate), and ≥ 12 (severe). The groups were compared based on different variables, including length of continuous albuterol and PICU stay.
Results:
The age distribution across all groups was similar. The median length of continuous albuterol was longest in the severe group with a duration of 21.5 h (11.5-27.5), compared to 15 (7.75-23.75) and 10 (5-15) in the moderate and mild groups, respectively (P = 0.001). The length of stay was longest in the severe group, with a stay of 35.6 h (22-49) compared to 26.5 (17-30) and 17.6 (12-29) in the moderate and mild groups, respectively (P = 0.001).
Conclusion:
A higher PASS is associated with a longer time on continuous albuterol, an increased likelihood to require noninvasive ventilation, and a longer stay in the ICU. This may help safely distribute asthmatics to lower and higher levels of care in the future.
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