title: An innovative childhood asthma score predicts the need for bronchodilator nebulization in children with acute asthma independent of auscultative findings.
abstract: BACKGROUND
  We sought to compare the accuracy of a newly developed childhood asthma score (CAS) with routine clinical assessment of respiratory status in children with acute asthma in predicting requirements for bronchodilator nebulization.
  
  
  METHODS
  In this prospective observational study in children 2-18 y old with acute asthma, we evaluated the association between the CAS and routine clinical assessment as well as inter-rater agreement.
  
  
  RESULTS
  The need for bronchodilator nebulization was assessed during 134 episodes of acute asthma in 47 children. Overall, bronchodilators were administered after routine clinical assessment in 74 episodes (55.2%). The median CAS was 2.5 (interquartile range of 2.0-3.0) for subjects who did not receive nebulization and 6.0 (interquartile range of 4.0-7.0) for subjects who did receive nebulization (P < .001). A CAS cutoff score of 4 yielded a sensitivity of 0.91 (95% CI 0.84-0.97) and a specificity of 0.77 (95% CI 0.66-0.87), with a positive predictive value of 0.83 (95% CI 0.75-0.91) and a negative predictive value of 0.87 (95% CI 0.78-0.96). In 79 episodes, the CAS was assessed by 2 independent raters. With a weighted kappa of 0.77, a good inter-rater agreement was obtained.
  
  
  CONCLUSIONS
  Using a cutoff value of 4, the newly developed CAS accurately predicts the requirement for bronchodilator nebulization in children with acute asthma without use of auscultative findings.
authors.affiliation: Department of Paediatrics arvidkamps@gmail.com.
authors.forename: Arvid W A
authors.initials: AW
authors.lastname: Kamps
authors.affiliation: Department of Clinical Epidemiology, MCL Academy, Medical Centre Leeuwarden, Leeuwarden, The Netherlands.
authors.forename: Nic J G M
authors.initials: NJ
authors.lastname: Veeger
authors.affiliation: Department of Paediatrics.
authors.forename: Sigrid M
authors.initials: SM
authors.lastname: Heijsman
mesh_terms: D000208:Acute Disease; D000280:Administration, Inhalation; D000293:Adolescent; D000420:Albuterol / Q000008:administration & dosage*; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D001314:Auscultation / Q000379:methods*; D001993:Bronchodilator Agents / Q000008:administration & dosage; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009330:Nebulizers and Vaporizers; D011379:Prognosis; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D000420:Albuterol
keywords: asthma; bronchodilators; child; dyspnea; symptom assessment; wheezing