Arvid W A Kamps1, Nic J G M Veeger2, Sigrid M Heijsman3. 1. Department of Paediatrics arvidkamps@gmail.com. 2. Department of Clinical Epidemiology, MCL Academy, Medical Centre Leeuwarden, Leeuwarden, The Netherlands. 3. Department of Paediatrics.
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.
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: Jerry Chacko; Charlotte King; David Harkness; Shrouk Messahel; Julie Grice; John Roe; Niall Mullen; Ian P Sinha; Daniel B Hawcutt Journal: J Am Coll Emerg Physicians Open Date: 2020-06-02
Authors: Valentina Fainardi; Carlo Caffarelli; Barbara Maria Bergamini; Loretta Biserna; Paolo Bottau; Elena Corinaldesi; Arianna Dondi; Martina Fornaro; Battista Guidi; Francesca Lombardi; Maria Sole Magistrali; Elisabetta Marastoni; Alessandra Piccorossi; Maurizio Poloni; Sylvie Tagliati; Francesca Vaienti; Cristina Venturelli; Giampaolo Ricci; Susanna Esposito Journal: Int J Environ Res Public Health Date: 2021-12-03 Impact factor: 3.390