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Validation of the Hospital Asthma Severity Score (HASS) in children ages 2-18 years old
Leah Abecassis1, Jonathan M Gaffin2,3, Peter W Forbes4
1Cardiovascular and Critical Care Services, Boston Children's Hospital, Boston, MA, USA.
Insights
The Hospital Asthma Severity Score (HASS) shows acceptable agreement for assessing pediatric inpatient asthma severity, supporting its use in clinical settings. This validation helps improve communication and management of asthma exacerbations.
Area of Science:
- Pediatric Pulmonology
- Clinical Assessment Tools
- Asthma Management
Background:
- The Hospital Asthma Severity Score (HASS) was developed to standardize communication of inpatient asthma severity.
- Accurate assessment is crucial for effective management of pediatric asthma exacerbations.
Purpose of the Study:
- To validate the HASS against the Pediatric Respiratory Assessment Measure (PRAM) and spirometry.
- To assess the reliability of HASS and PRAM in evaluating asthma exacerbation severity in children aged 2-18 years.
Main Methods:
- Prospective study involving 58 pediatric patients admitted with asthma.
- Assessed asthma severity using HASS, PRAM, and spirometry.
- Evaluated inter-rater and intra-rater agreement for HASS and PRAM scores.
Main Results:
- HASS demonstrated 79% inter-rater agreement (continuous scores) and 62% (categorized scores).
- PRAM showed 60% inter-rater agreement (continuous scores) and 93% (categorized scores).
- Weak correlations were found between HASS/PRAM and FEV1, suggesting limited agreement with spirometry.
Conclusions:
- Both HASS and PRAM exhibit acceptable inter-rater and intra-rater reliability.
- Findings support the HASS as a validated tool for managing hospitalized pediatric patients with asthma exacerbations.
Introduction:
The Hospital Asthma Severity Score (HASS) was developed to communicate inpatient asthma severity between providers. The purpose of this prospective study was to validate the HASS against the Pediatric Respiratory Assessment Measure (PRAM) and spirometry for assessment of inpatient asthma exacerbation severity in patients 2-18 years old, at a single point-in-time.
Methods:
This study was registered with clinicaltrials.gov (NCT02782065). Children admitted to a tertiary care, free-standing children's hospital were assessed for asthma severity using the HASS, PRAM, and pulmonary function by spirometry. Inter-rater agreement of HASS and PRAM scores was assessed between two blinded clinician raters. Spirometry results were obtained by a certified pulmonary laboratory technician and correlated with HASS and PRAM scores.
Results:
The sample included 58 subjects. Allowing for a one-point difference in continuous HASS and PRAM scores, inter-rater agreement was 79% for the HASS and 60% for the PRAM. When the scores were categorized as mild, moderate, and severe, inter-rater agreement was 62% for the HASS and 93% for the PRAM (p < .0001). Additionally, intra-rater agreement between HASS and PRAM severity categories was 71% for Rater 1 and 64% for Rater 2. A weak correlation was noted between both the HASS and FEV1 (r = -0.31; p = 0.11), and PRAM and FEV1 (r = -0.30; p = 0.11) for the 29 subjects with acceptable spirometry results.
Conclusions:
The HASS and PRAM have acceptable inter-rater and intra-rater agreement. These results support validation of the HASS for managing hospitalized patients during asthma exacerbations.
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