Prospective Evaluation of Two Clinical Scores for Acute Asthma in Children 18 Months to 7 Years of Age

Authors

  • Serge Gouin MDCM, FRCPC,

    1. From the Division of Emergency Medicine, Department of Pediatrics, CHU Ste-Justine, Université de Montréal (SG, IR, JG), Montréal, Quebec, Canada; the Division of Emergency Medicine, CHUQ pavillon CHUL, Université Laval (CG), Laval, Quebec, Canada; the Division of Emergency Medicine, Department of Pediatrics, The Montreal Children’s Hospital, McGill University (DC), Montréal, Quebec, Canada; and the Research Institute, CHU Ste-Justine (DA), Montréal, Quebec, Canada.
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  • Isabelle Robidas MD, FRCPC,

    1. From the Division of Emergency Medicine, Department of Pediatrics, CHU Ste-Justine, Université de Montréal (SG, IR, JG), Montréal, Quebec, Canada; the Division of Emergency Medicine, CHUQ pavillon CHUL, Université Laval (CG), Laval, Quebec, Canada; the Division of Emergency Medicine, Department of Pediatrics, The Montreal Children’s Hospital, McGill University (DC), Montréal, Quebec, Canada; and the Research Institute, CHU Ste-Justine (DA), Montréal, Quebec, Canada.
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  • Jocelyn Gravel MD, FRCPC, MSc (Epid),

    1. From the Division of Emergency Medicine, Department of Pediatrics, CHU Ste-Justine, Université de Montréal (SG, IR, JG), Montréal, Quebec, Canada; the Division of Emergency Medicine, CHUQ pavillon CHUL, Université Laval (CG), Laval, Quebec, Canada; the Division of Emergency Medicine, Department of Pediatrics, The Montreal Children’s Hospital, McGill University (DC), Montréal, Quebec, Canada; and the Research Institute, CHU Ste-Justine (DA), Montréal, Quebec, Canada.
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  • Chantal Guimont MD, PhD (Epid),

    1. From the Division of Emergency Medicine, Department of Pediatrics, CHU Ste-Justine, Université de Montréal (SG, IR, JG), Montréal, Quebec, Canada; the Division of Emergency Medicine, CHUQ pavillon CHUL, Université Laval (CG), Laval, Quebec, Canada; the Division of Emergency Medicine, Department of Pediatrics, The Montreal Children’s Hospital, McGill University (DC), Montréal, Quebec, Canada; and the Research Institute, CHU Ste-Justine (DA), Montréal, Quebec, Canada.
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  • Dominic Chalut MD, FRCPC, ABP (EM),

    1. From the Division of Emergency Medicine, Department of Pediatrics, CHU Ste-Justine, Université de Montréal (SG, IR, JG), Montréal, Quebec, Canada; the Division of Emergency Medicine, CHUQ pavillon CHUL, Université Laval (CG), Laval, Quebec, Canada; the Division of Emergency Medicine, Department of Pediatrics, The Montreal Children’s Hospital, McGill University (DC), Montréal, Quebec, Canada; and the Research Institute, CHU Ste-Justine (DA), Montréal, Quebec, Canada.
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  • Devendra Amre PhD (Epid)

    1. From the Division of Emergency Medicine, Department of Pediatrics, CHU Ste-Justine, Université de Montréal (SG, IR, JG), Montréal, Quebec, Canada; the Division of Emergency Medicine, CHUQ pavillon CHUL, Université Laval (CG), Laval, Quebec, Canada; the Division of Emergency Medicine, Department of Pediatrics, The Montreal Children’s Hospital, McGill University (DC), Montréal, Quebec, Canada; and the Research Institute, CHU Ste-Justine (DA), Montréal, Quebec, Canada.
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  • Presented at the Society for Academic Emergency Medicine annual meeting, Washington, DC, May 2008.

  • This study was funded by a local internal grant of the Research Centre of the CHU Sainte-Justine. There are no financial arrangements that may represent conflict of interest.

Address for correspondenceand reprints: Serge Gouin, MDCM, FRCPC; e-mail: sergegouin@aol.com.

Abstract

Objectives:  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.

ACADEMIC EMERGENCY MEDICINE 2010; 17:598–603 © 2010 by the Society for Academic Emergency Medicine

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