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Comparison of Two Assessment Tools for Hospitalized Subjects With Asthma
Sangeeta K Schroeder1, Waheeda Samady2, Irini N Kolaitis1
1Northwestern University Feinberg School of Medicine, Chicago, Illinois and Ann and Robert H. Lurie Children's Hospital of Chicago.
Insights
The asthma score demonstrated superior clinical predictability and correlation compared to the asthma scale in pediatric patients. This numerical scoring system offers more objective assessments for managing inpatient asthma care.
Area of Science:
- Pediatric Pulmonology
- Clinical Assessment Tools
- Asthma Management
Background:
- Inpatient pediatric asthma assessment tools require validation for inhaled therapy weaning.
- This study compared a novel asthma score against a standard asthma scale.
Purpose of the Study:
- To evaluate and compare the clinical predictability, correlation, and usability of an asthma scale versus an asthma score.
- To determine which tool offers more objective assessment for inpatient asthma management.
Main Methods:
- A prospective, physician-blinded comparison study involving pediatric patients with status asthmaticus.
- Assessed 5 components (oxygen, auscultation, dyspnea, breathing frequency, pulse oximetry) using a categorical scale (mild, moderate, severe) and a numerical score (1-15).
- Evaluated predictability via continuous albuterol duration, clinician agreement using Cohen kappa, clinical correlation using Spearman coefficient, and usability via surveys.
Main Results:
- The asthma score showed better predictability (AUC 0.80 vs. 0.62) and clinical correlation (r=0.80 vs. r=0.57) compared to the asthma scale.
- Clinician agreement was higher for the asthma score (kappa=0.55 early, 0.41 late) than the asthma scale (kappa=0.34 early, 0.38 late).
- Usability scores favored the asthma score (3.68 vs. 3.38).
Conclusions:
- The asthma score provides superior clinical predictability and correlation for pediatric inpatient asthma assessment.
- Numerical scoring systems enhance objectivity in asthma assessment compared to categorical scales.
- Validated tools like the asthma score are essential for effective inpatient asthma care management.
Background:
Pediatric Asthma Assessment tools used to guide the weaning of inhaled therapies during inpatient hospitalization require further evaluation and validation. This study aimed to compare 2 asthma assessment tools: an asthma scale versus an asthma score.
Methods:
A prospective, physician-blinded, comparison study was conducted in 2 separate 6-week phases of patients > 2 y old admitted to a tertiary care children's hospital with status asthmaticus between July and November 2014. The asthma scale categorized 5 components (oxygen, auscultation, dyspnea, breathing frequency, and pulse oximetry) into 1 of 3 respiratory assessments: mild, moderate, or severe. The asthma score used a sum of the components, resulting in a score of 1-15. Study tool predictability was measured using a metric based on hours on continuous albuterol, with area under the curve ≥ 0.8 indicating good predictability. Agreement between clinicians was measured using the Cohen kappa statistic. Study tool clinical correlation was measured using Spearman coefficient. Usability was evaluated using web-based surveys.
Results:
Phase 1 included 1,971 assessments (97 unique subjects), whereas phase 2 included 607 assessments (69 unique subjects). Using the continuous albuterol metric, predictability of the asthma scale had an area under the curve of 0.62 versus the asthma score area under the curve of 0.80. Agreement early in hospitalization for the asthma scale was kappa = 0.34 (95% CI 0.18-0.5; n = 84) versus kappa = 0.55 (95% CI 0.35-0.76; n = 44) for the asthma score. Agreement late in hospitalization for the asthma scale was kappa = 0.38 (95% CI 0.17-0.59; n = 66) versus kappa = 0.41 (95% CI 0.13-0.69; n = 33) for the asthma score. Clinical correlation for the asthma scale (no. = 1,908) was r = 0.57 (P < .001) versus r = 0.80 (P < .001) for the asthma score (no. = 558). Mean asthma scale usability was 3.38 versus 3.68 for the asthma score.
Conclusions:
The asthma score showed better clinical predictability and clinical correlation compared to the asthma scale. Numerical scores provided more objective assessments compared to categorical scores. Validated scoring tools such as the asthma score are crucial to the success of management of inpatient asthma care.
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