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The Clinical Respiratory Score: investigating the reliability of an asthma scoring tool across a multidisciplinary
Patrick McLaughlin1, Rosa C Banuelos2, Elizabeth A Camp2
1Department of Emergency Medicine, Division of Pediatric Emergency Medicine, VCU Health, Richmond, VA, USA.
Insights
The Clinical Respiratory Score (CRS) reliably assesses pediatric asthma exacerbation severity among emergency department teams. Simplifying the CRS did not impact its reliability for multidisciplinary use.
Area of Science:
- Pediatric Emergency Medicine
- Respiratory Care
- Clinical Assessment Tools
Background:
- Asthma scoring tools are crucial for emergency department (ED) teams to communicate illness severity.
- Existing tools lack sufficient validation for multidisciplinary pediatric asthma management.
Purpose of the Study:
- To evaluate the inter-rater reliability of the Clinical Respiratory Score (CRS) among all members of an ED care team.
- To determine if the CRS is a valid tool for assessing pediatric asthma exacerbations across different healthcare providers.
Main Methods:
- Retrospective study of children (2-18 years) with acute asthma exacerbations in a pediatric ED over 2 years.
- Assessed inter-rater reliability using two CRS measurements 15 minutes apart.
- Calculated inter-class correlation coefficient (ICC) and performed subgroup analysis.
Main Results:
- 1,562 patient encounters met inclusion criteria out of 9,749.
- Overall CRS reliability was acceptable (ICC = 0.76).
- Removing specific CRS components did not alter overall reliability.
Conclusions:
- The Clinical Respiratory Score (CRS) is a reliable tool for assessing pediatric asthma exacerbation severity among multidisciplinary ED teams.
- The CRS can be simplified by removing the color and mental status components without compromising reliability.
Background:
Asthma scoring tools are used by emergency department (ED) teams to communicate severity of illness. Although most have been validated, none has been found to be sufficiently valid to allow for use across a multidisciplinary team managing pediatric asthma exacerbations.
Objective:
We sought to evaluate the inter-rater reliability of the Clinical Respiratory Score (CRS) among all members of an ED care team.
Design/Methods:
We conducted a retrospective study of children aged 2 to 18 years presenting with an acute asthma exacerbation to an urban pediatric ED over a 2-year period. We determined reliability using two CRS measurements independently documented by two separate providers, 15 min apart. An inter-class correlation coefficient (ICC) was calculated to determine overall reliability among users. Subgroup analysis was conducted to determine reliability between types of providers and the six components of the CRS.
Results:
A total of 9,749 patient encounters were identified and 1,562 (16%) met our inclusion criteria. The majority of score pairings (n = 1096, 70.2%) were documented by a registered nurse followed by a respiratory therapist. The overall reliability of the CRS, when documented by two providers, was acceptable with an ICC of 0.76 (95% CI: 0.74-0.78, p < 0.001). Removing CRS components with the lowest agreement did not affect the overall ICC when re-calculated.
Conclusion(S):
The CRS is a reliable asthma severity scoring tool for pediatric patients presenting with an acute asthma exacerbation when utilized across care team members. Simplifying the CRS by removing the color and mental status components did not affect its reliability.
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