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  11. Performance Of The Asthma Clinical Score And The Pediatric Respiratory Assessment Measure In Obese Children Presenting To The Emergency Department For Asthma Exacerbations

Performance of the asthma clinical score and the Pediatric Respiratory Assessment Measure in obese children presenting to the emergency department for asthma exacerbations

Adjoa A Andoh1,2, Annie Truelove1,3, Sara Helwig1,3

  • 1Division of Emergency Medicine, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA.

The Journal of Asthma : Official Journal of the Association for the Care of Asthma
|December 27, 2025

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View abstract on PubMed

Summary
This summary is machine-generated.

Asthma severity scores performed differently in obese versus normal weight children. The Asthma Clinical Score (ACS) and Pediatric Respiratory Assessment Measure (PRAM) showed varied reliability and predictive validity, highlighting the need for further research in pediatric obesity.

Area of Science:

  • Pediatric Pulmonology
  • Clinical Epidemiology

Background:

  • Asthma severity assessment in children is crucial for effective management.
  • Obesity is a growing concern in pediatric populations and may impact asthma presentation and management.
  • Existing asthma severity scores may have variable performance in different weight categories.

Purpose of the Study:

  • To evaluate the interrater reliability (IRR), responsiveness, and predictive validity of the Asthma Clinical Score (ACS) and Pediatric Respiratory Assessment Measure (PRAM) in obese and normal weight (NW) children.
  • To compare asthma interventions received by obese versus NW children.

Main Methods:

  • A secondary analysis of a prospective observational study involving children aged 2 to <18 years treated for asthma exacerbations.
  • Obesity defined as >95th% sex-specific weight-for-age.
Keywords:
Pediatricspredictionreliabilitytreatment

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  • Paired assessments using ACS and PRAM, with IRR analyzed by Cohen's kappa, responsiveness by reliable change index, and predictive validity by ROC and AIC. Intervention likelihood assessed using odds ratios (OR).

    • Main Results:

    • In obese children, ACS showed moderate IRR (κw 0.73) and PRAM showed weak IRR (κw 0.57).
    • Both scores detected responsiveness better in NW children (ACS 34%, PRAM 28%) compared to obese children (ACS 23%, PRAM 3.7%).
    • However, both scores were better predictors of hospitalization in obese children (ACS 0.85, PRAM 0.79) versus NW children (ACS 0.74, PRAM 0.72). Obese children received more intensive interventions.

    Conclusions:

    • The performance of the ACS and PRAM in assessing asthma severity differs between obese and normal weight children.
    • Further research is needed to fully understand the performance and clinical utility of asthma severity scores in the pediatric obese population.
    weight