title: Systematic review: insufficient validation of clinical scores for the assessment of acute dyspnoea in wheezing children.
abstract: BACKGROUND
  A reliable, valid, and easy-to-use assessment of the degree of wheeze-associated dyspnoea is important to provide individualised treatment for children with acute asthma, wheeze or bronchiolitis.
  
  
  OBJECTIVE
  To assess validity, reliability, and utility of all available paediatric dyspnoea scores.
  
  
  METHODS
  Systematic review. We searched Pubmed, Cochrane library, National Guideline Clearinghouse, Embase and Cinahl for eligible studies. We included studies describing the development or use of a score, assessing two or more clinical symptoms and signs, for the assessment of severity of dyspnoea in an acute episode of acute asthma, wheeze or bronchiolitis in children aged 0-18 years. We assessed validity, reliability and utility of the retrieved dyspnoea scores using 15 quality criteria.
  
  
  RESULTS
  We selected 60 articles describing 36 dyspnoea scores. Fourteen scores were judged unsuitable for clinical use, because of insufficient face validity, use of items unsuitable for children, difficult scoring system or because complex auscultative skills are needed, leaving 22 possibly useful scores. The median number of quality criteria that could be assessed was 7 (range 6-11). The median number of positively rated quality criteria was 3 (range 1-5). Although most scores were easy to use, important deficits were noted in all scores across the three methodological quality domains, in particular relating to reliability and responsiveness.
  
  
  CONCLUSIONS
  None of the many dyspnoea scores has been sufficiently validated to allow for clinically meaningful use in children with acute dyspnoea or wheeze. Proper validation of existing scores is warranted to allow paediatric professionals to make a well balanced decision on the use of the dyspnoea score most suitable for their specific purpose.
authors.affiliation: Princess Amalia Children's Clinic, Isala klinieken, Zwolle, The Netherlands. Electronic address: j.bekhof@isala.nl.
authors.forename: Jolita
authors.initials: J
authors.lastname: Bekhof
authors.affiliation: Princess Amalia Children's Clinic, Isala klinieken, Zwolle, The Netherlands.
authors.forename: Roelien
authors.initials: R
authors.lastname: Reimink
authors.affiliation: Princess Amalia Children's Clinic, Isala klinieken, Zwolle, The Netherlands.
authors.forename: Paul L P
authors.initials: PL
authors.lastname: Brand
mesh_terms: D000208:Acute Disease; D002648:Child; D004417:Dyspnea / Q000175:diagnosis* / Q000209:etiology; D006801:Humans; D015203:Reproducibility of Results; D012135:Respiratory Sounds / Q000175:diagnosis*; D012720:Severity of Illness Index
keywords: Asthma; Bronchiolitis; Index; Reliability; Validation