Performance of the Asthma Clinical Score in the Evaluation of Acute Asthma in the Emergency Department.

Objective: The primary objective of this study was to examine the performance of the Asthma Clinical Score (ACS) relative to the Pediatric Respiratory Assessment Measure (PRAM). Our secondary objectives were to determine interrater reliability, discriminative validity, responsiveness, and predictive validity of the ACS and PRAM.

Methods: This was a single-site prospective observational study of children ages 2 to < 18 years presenting to the emergency department (ED) for asthma exacerbations. Clinicians completed paired assessments using ACS and PRAM at three time points of each patients ED stay. Construct validity correlating the performance of the ACS to PRAM, and interrater reliability were analyzed using Spearmen's rank correlation coefficients and Cohen's kappa coefficient, respectively. Cohen's d was calculated to compare the scores of patients who received certain treatments to patients who did not. Reliable change index (RCI) was used to determine the responsiveness of each score. Predictive validity for hospitalization was analyzed using Area Under the Receiver Operating Characteristic curve (AUROCc) and Akaike Information Criterion (AIC).

Results: 399 children were enrolled with 338 paired clinician observations. The ACS and PRAM scores were strongly correlated at all time points (n = 1383,  = 0.874). Both the ACS and PRAM showed moderate interrater reliability at all time points (n = 338, κ = 0.77 and κ = 0.69, respectively). Patients receiving albuterol nebulization or adjunctive medications had higher average ACS and PRAM scores. ACS showed a better ability to detect responsiveness than the PRAM (31% vs 15% respectively). The pretreatment ACS showed comparable predictive validity to the PRAM.

Conclusion: The ACS was highly correlated with PRAM and is a reliable score in this cohort. The ACS showed good discriminative validity, predictive validity and responsiveness. This study supports the ACS as a useful tool in ED assessment of asthma exacerbation severity in children.