Lack of agreement in classification of the severity of acute asthma between emergency physician assessment and classification using the National Asthma Council Australia guidelines (1998).
OBJECTIVE
To determine the level of agreement in classification of the severity of acute asthma at presentation to the emergency department, between emergency physician global assessment and severity classification according to the National Asthma Council Guidelines, Australia 1998 (NACG).


METHODS
Prospective observational study in emergency departments throughout Australia, participating in the Asthma Snapshot 2000 project. Patients between the ages of one and 60 years presenting to participating emergency departments with acute asthma between 21 August and 3 September 2000 were included. Data collected were emergency physician global assessment of asthma severity and severity classification according to the National Asthma Council Guidelines and disposition.


RESULTS
Five hundred and five subjects had completed data for emergency physician assessment of severity and for calculation of severity classification according to the National Asthma Council Guidelines. Weighted kappa for agreement in classification was 0.48 (95% confidence interval: 0.40, 0.56). Emergency physicians assess asthma as less severe compared to the National Asthma Council Guidelines assessment.


CONCLUSIONS
Agreement between physician assessment of severity of acute asthma and severity classification according to National Asthma Council Guidelines is only moderate. This may have implications in treatment and disposition. This also suggests that emergency physicians may be using other methods to classify acute asthma than the National Asthma Council Guidelines classification.
Powell
Colin V E
CV
Department of Emergency Medicine and Pediatrics, Royal Children's Hospital, Melbourne, Australia.
Kelly
Anne-Maree
AM
Kerr
Debra
D
D001249:Asthma / Q000145:classification* / Q000453:epidemiology; D001315:Australia; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D006801:Humans; D015588:Observer Variation; D017410:Practice Guidelines as Topic; D012720:Severity of Illness Index