Pitfalls in the use of clinical asthma scoring

We evaluated the correlation of the Wood-Downes-Lecks clinical asthma score (CAS) with outcome in 210 consecutive known asthmatic children presenting to an urban emergency department for treatment of acute asthma. All children received standard treatment consisting of administration of beta-adrenergic agents and theophylline compounds. Clinical asthma scores were assigned before each treatment phase and before disposition from the emergency department. Ten-day follow-up information was collected on each patient by telephone. While no differences in pretreatment CASs were found between outcome groups, disposition CASs were found to be significantly higher in patients eventually admitted to the hospital as opposed to those discharged home. However, CASs were not effective in identifying either those patients who required prolonged hospitalization (greater than 24 hours) or those who sustained ongoing disability following discharge home from the emergency department. These data indicate that the CAS alone is not a reliable indicator of severity of acute asthma of childhood as judged by subsequent disability.