Performance of a Novel Clinical Score, the Pediatric Asthma Severity Score (PASS), in the Evaluation of Acute Asthma

Abstract

Objectives: To evaluate the reliability, validity, and responsiveness of a new clinical asthma score, the Pediatric Asthma Severity Score (PASS), in children aged 1 through 18 years in an acute clinical setting. Methods: This was a prospective cohort study of children treated for acute asthma at two urban pediatric emergency departments (EDs). A total of 852 patients were enrolled at one site and 369 at the second site. Clinical findings were assessed at the start of the ED visit, after one hour of treatment, and at the time of disposition. Peak expiratory flow rate (PEFR) (for patients aged 6 years and older) and pulse oximetry were also measured. Results: Composite scores including three, four, or five clinical findings were evaluated, and the threeitem score (wheezing, prolonged expiration, and work of breathing) was selected as the PASS. Interobserver reliability for the PASS was good to excellent (kappa ¼ 0.72 to 0.83).There was a significant correlation between PASS and PEFR (r ¼ 0.27 to 0.37) and pulse oximetry (r ¼ 0.29 to 0.41) at various time points. The PASS was able to discriminate between those patients who did and did not require hospitalization, with area under the receiver operating characteristic curve of 0.82. Finally, the PASS was shown to be responsive, with a 48% relative increase in score from start to end of treatment and an overall effect size of 0.62, indicating a moderate to large effect. Conclusions: This clinical score, the PASS, based on three clinical findings, is a reliable and valid measure of asthma severity in children and shows both discriminative and responsive properties. The PASS may be a useful tool to assess acute asthma severity for clinical and research purposes.

Effect of a clinical pathway on the hospitalisation rates of children with asthma: a prospective study

“…Our severity assessment method was modified from that of Schuh et al, 56 using reliable and validated parameters. [62][63][64][65][66][67][68] Limitations This study was limited to a single, urban, paediatric tertiary care emergency department; our findings may therefore not be generalisable to other settings. Knowledge that the child was being managed under a clinical pathway may have unduly influenced hospitalisation decisions, as would a potential Hawthorne effect.…”

Correlation of a Unique “Los Angeles” Phonospirometry Technique with Peak Expiratory Flows in Children with Asthma

“…Unlike the Pediatric Respiratory Assessment Measure (PRAM) or the Pediatric Asthma Severity Score (PASS), which require pulse oximetry and assessment by a nurse or physician (14)(15)(16)(17), phonospirometry may be selfperformed, outside of the health care setting. The LA technique should not replace these clinical scores, or any other clinical score, but rather this phonospirometry technique may be used adjunctively, much as PEF measurement may be utilized.…”

The asthma prediction rule to decrease hospitalizations for children with asthma

“…This may result in circular reasoning because the score components are used by clinicians to make hospitalization decisions, yet the hospitalization decision is used to ‘validate’ the score. [28, 31, 32] Biostatistical standards for prediction rule modeling and validation circumvent this limitation by masking individuals making clinical decisions from knowledge of the value of predictor variables used in prediction rule modeling. As a result, each patient’s outcome is determined without knowledge of the measured predictor variables.…”