Asthma severity scores for preschoolers displayed weaknesses in reliability, validity, and responsiveness

Birken, Catherine S.; Parkin, Patricia C.; Macarthur, Colin

doi:10.1016/j.jclinepi.2004.02.016

Cited by 60 publications

(67 citation statements)

References 18 publications

(16 reference statements)

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“…2 Severe acute asthma is currently the most common medical emergency in children and is responsible for nearly half a million admissions to the pediatric intensive care unit (PICU) each year. 1,3,4 Different terms have been described for severe acute asthma exacerbation, which include status asthmaticus, near-fatal asthma, sudden asphyxic asthma, and acute fatal asthma. Status asthmaticus refers to an acute asthma exacerbation in which bronchial obstruction is severe and continues to worsen or not improve despite the institution of adequate standard therapy, leading to respiratory failure.…”

Section: Definitionmentioning

confidence: 99%

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Nievas

Anand

2013

The Journal of Pediatric Pharmacology and Therapeutics

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OBJECTIVES An increasing prevalence of pediatric asthma has led to increasing burdens of critical illness in children with severe acute asthma exacerbations, often leading to respiratory distress, progressive hypoxia, and respiratory failure. We review the definitions, epidemiology, pathophysiology, and clinical manifestations of severe acute asthma, with a view to developing an evidence-based, stepwise approach for escalating therapy in these patients. METHODS Subject headings related to asthma, status asthmaticus, critical asthma, and drug therapy were used in a MEDLINE search , supplemented by a manual search of personal files, references cited in the reviewed articles, and treatment algorithms developed within Le Bonheur Children's Hospital. RESULTS Patients with asthma require continuous monitoring of their cardiorespiratory status via noninvasive or invasive devices, with serial clinical examinations, objective scoring of asthma severity (using an objective pediatric asthma score), and appropriate diagnostic tests. All patients are treated with β-agonists, ipratropium, and steroids (intravenous preferable over oral preparations). Patients with worsening clinical status should be progressively treated with continuous β-agonists, intravenous magnesium, helium-oxygen mixtures, intravenous terbutaline and/or aminophylline, coupled with high-flow oxygen and non-invasive ventilation to limit the work of breathing, hypoxemia, and possibly hypercarbia. Sedation with low-dose ketamine (with or without benzodiazepines) infusions may allow better toleration of non-invasive ventilation and may also prepare the patient for tracheal intubation and mechanical ventilation, if indicated by a worsening clinical status. CONCLUSIONS Severe asthma can be a devastating illness in children, but most patients can be managed by using serial objective assessments and the stepwise clinical approach outlined herein. Following multidisciplinary education and training, this approach was successfully implemented in a tertiary-care, metropolitan children's hospital. INDEX TERMS asthma, child, critical care, infant, respiratory failure, status asthmaticus J Pediatr Pharmacol Ther 2013;18(2):88-104

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Section: Definitionmentioning

confidence: 99%

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Nievas

Anand

2013

The Journal of Pediatric Pharmacology and Therapeutics

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“…[13][14][15]25 These results reflect the pathophysiology and clinical correlates of respiratory distress in bronchiolitis. It is known that as disease progresses and severity increases, so do the disturbances in ventilation and ventilation-perfusion matching.…”

Section: 18mentioning

confidence: 77%

“…Evidence is limited regarding RDAI and RACS measurement properties and their suitability for use as evaluative instruments in clinical trials. [13][14][15] Previous RCTs have reported some data on which reliability and validity can be assessed, whereas the first formal validation study is recent. 16 The aim of this study was to assess and compare the measurement properties of RDAI and RACS, that is, validity, reliability, and responsiveness.…”

Section: What This Study Addsmentioning

confidence: 99%

“…The RDAI was evaluated in 3 systematic reviews of measurement properties of asthma or wheezing severity scales in children. [13][14][15] Limited data on its reliability and responsiveness were provided in the original description of the scale and in later reports of RCTs. 12,19,24 However, none of these were adequately designed measurement studies, and no formal assessment of validity was found.…”

Section: Figurementioning

confidence: 99%

“…Measurement properties from other respiratory scales or their individual items, which often include respiratory rate or SaO 2 , are seldom available. [13][14][15] When they are reported, there is substantial heterogeneity in correlations with SaO 2 , ranging from poor to moderate. Thus, our predefined cutoffs may have been too strict.…”

Section: Figurementioning

confidence: 99%

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Validity of Bronchiolitis Outcome Measures

et al. 2015

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Effect of Nebulized Magnesium vs Placebo Added to Albuterol on Hospitalization Among Children With Refractory Acute Asthma Treated in the Emergency Department

Schuh

Sweeney

Rumantir

et al. 2020

JAMA

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IMPORTANCE While intravenous magnesium decreases hospitalizations in refractory pediatric acute asthma, it is variably used because of invasiveness and safety concerns. The benefit of nebulized magnesium to prevent hospitalization is unknown.OBJECTIVE To evaluate the effectiveness of nebulized magnesium in children with acute asthma remaining in moderate or severe respiratory distress after initial therapy. DESIGN, SETTING, AND PARTICIPANTSA randomized double-blind parallel-group clinical trial from September 26, 2011, to November 19, 2019, in 7 tertiary-care pediatric emergency departments in Canada. The participants were otherwise healthy children aged 2 to 17 years with moderate to severe asthma defined by a Pediatric Respiratory Assessment Measure (PRAM) score of 5 or greater (on a 12-point scale) after a 1-hour treatment with an oral corticosteroid and 3 inhaled albuterol and ipratropium treatments. Of 5846 screened patients, 4332 were excluded for criteria, 273 declined participation, 423 otherwise excluded, 818 randomized, and 816 analyzed.INTERVENTIONS Participants were randomized to 3 nebulized albuterol treatments with either magnesium sulfate (n = 410) or 5.5% saline placebo (n = 408). MAIN OUTCOMES AND MEASURESThe primary outcome was hospitalization for asthma within 24 hours. Secondary outcomes included PRAM score; respiratory rate; oxygen saturation at 60, 120, 180, and 240 minutes; blood pressure at 20, 40, 60, 120, 180, and 240 minutes; and albuterol treatments within 240 minutes. RESULTS Among 818 randomized patients (median age, 5 years; 63% males), 816 completed the trial (409 received magnesium; 407, placebo). A total of 178 of the 409 children who received magnesium (43.5%) were hospitalized vs 194 of the 407 who received placebo (47.7%) (difference, −4.2%; absolute risk difference 95% [exact] CI, −11% to 2.8%]; P = .26). There were no significant between-group differences in changes from baseline to 240 minutes in PRAM score (difference of changes, 0.14 points [95% CI, −0.23 to 0.50]; P = .46); respiratory rate (0.17 breaths/min [95% CI, −1.32 to 1.67]; P = .82); oxygen saturation (−0.04% [95% CI, −0.53% to 0.46%]; P = .88); systolic blood pressure (0.78 mm Hg [95% CI, −1.48 to 3.03]; P = .50); or mean number of additional albuterol treatments (magnesium: 1.49, placebo: 1.59; risk ratio, 0.94 [95% CI, 0.79 to 1.11]; P = .47). Nausea/vomiting or sore throat/nose occurred in 17 of the 409 children who received magnesium (4%) and 5 of the 407 who received placebo (1%).CONCLUSIONS AND RELEVANCE Among children with refractory acute asthma in the emergency department, nebulized magnesium with albuterol, compared with placebo with albuterol, did not significantly decrease the hospitalization rate for asthma within 24 hours. The findings do not support use of nebulized magnesium with albuterol among children with refractory acute asthma.

show abstract

Asthma severity scores for preschoolers displayed weaknesses in reliability, validity, and responsiveness

Cited by 60 publications

References 18 publications

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Severe Acute Asthma Exacerbation in Children: A Stepwise Approach for Escalating Therapy in a Pediatric Intensive Care Unit

Validity of Bronchiolitis Outcome Measures

Effect of Nebulized Magnesium vs Placebo Added to Albuterol on Hospitalization Among Children With Refractory Acute Asthma Treated in the Emergency Department

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