Prospective evaluation of two clinical scores for acute asthma in children 18 months to 7 years of age.
OBJECTIVE
The objective was to evaluate the discriminatory ability of two clinical asthma scores, the Preschool Respiratory Assessment Measure (PRAM) and the Pediatric Asthma Severity Score (PASS), during an asthma exacerbation.


METHODS
This was a prospective cohort study in an academic pediatric emergency department (ED; 60,000 visits/year) conducted from March 2006 to October 2007. All patients 18 months to 7 years of age who presented for an asthma exacerbation were eligible. The primary outcome was a length of stay (LOS) of >6 hours in the ED or admission to the hospital. Clinical findings and components of the PRAM and the PASS were assessed by a respiratory therapist (RT) at the start of the ED visit and after 90 minutes of treatment.


RESULTS
During the study period, 3,845 patients were seen in the ED for an asthma exacerbation. Of these, 291 were approached to participate, and eight refused. Moderate levels of discrimination were found between a LOS of >6 hours and/or admission and PRAM (area under the receiver-operating characteristic curve [AUC] = 0.69, 95% confidence interval [CI] = 0.59 to 0.79) and PASS (AUC = 0.70, 95% CI = 0.60 to 0.80) as calculated at the start of the ED visit. Significant similar correlations were seen between the physician's judgment of severity and PRAM (r = 0.54, 95% CI = 0.42 to 0.65) and PASS (r = 0.55, 95% CI = 0.43 to 0.65).


CONCLUSIONS
The PRAM and PASS clinical asthma scores appear to be measures of asthma severity in children with discriminative properties.
Gouin
Serge
S
Division of Emergency Medicine, Department of Pediatrics, CHU Ste-Justine, Université de Montréal, Montréal, Quebec, Canada. sergegouin@aol.com
Robidas
Isabelle
I
Gravel
Jocelyn
J
Guimont
Chantal
C
Chalut
Dominic
D
Amre
Devendra
D
D001249:Asthma / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index