[The usefulness of a clinical scoring system and pulse oximetry (SaO2) in assessing the severity of asthmatic crises].
OBJECTIVE
To evaluate the ability of the Wood-Downes modified score (SPC) and the pulse oximetry to identify children with acute asthma who need hospitalization.


METHODS
One hundred twenty-one children were evaluated before (SPC-1, SaO2-1) and after (SPC-2, SaO2-2) nebulized salbutamol.


RESULTS
Nebulization with salbutamol improved both SPC and SaO2 (p < 0.001). A correlation was found between SPC-1 and SaO2-1 (r = -0.44, p < 0.001). The admitted patients differed significantly from the discharged ones in all four variables analyzed. No statistically significant difference was found to predict admission when a receiver operating characteristic curve was done between SPC-1 and SaO2-1. On the other hand, SPC-2 values predicted admission better than SaO2-2 (p < 0.0001). The cut-off points were considered to be: SPC-1 > or = 4; SaO2-1 < or = 91; SPC-2 > or = 2; and SaO2-2 < or = 96, with sensitivities of 60%, 47%, 100% and 47% and specificities of 76%, 92%, 69% and 84%, respectively.


CONCLUSIONS
1. Both pulse oximetry and clinical SPC improved after treatment. 2. All four variables analyzed predict the need for hospitalization with no differences between SPC-1 and SaO2-1, with SPC-2 being better in predicting admission than SaO2-2.3. Pulse oximetry is an objective method, complementary to clinical judgement in deciding whether to hospitalize.
Luaces Cubells
C
C
Servicio de Pediatría, Unidad Integrada, Hospital Clinic Sant Joan de Déu, Universitat de Barcelona.
García García
J J
JJ
Garrón Torrico
P
P
Sánchez Mora
M L
ML
Camacho Díaz
E
E
D000293:Adolescent; D001986:Bronchial Spasm / Q000175:diagnosis; D002648:Child; D002675:Child, Preschool; D004630:Emergencies; D005069:Evaluation Studies as Topic; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D008991:Monitoring, Physiologic; D010092:Oximetry / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013224:Status Asthmaticus / Q000175:diagnosis*