Clinical Scores for Dyspnoea Severity in Children: A Prospective Validation Study

Abstract

BackgroundIn acute dyspnoeic children, assessment of dyspnoea severity and treatment response is frequently based on clinical dyspnoea scores. Our study aim was to validate five commonly used paediatric dyspnoea scores.MethodsFifty children aged 0–8 years with acute dyspnoea were clinically assessed before and after bronchodilator treatment, a subset of 27 children were videotaped and assessed twice by nine observers. The observers scored clinical signs necessary to calculate the Asthma Score (AS), Asthma Severity Score (ASS), Clinical Asthma Evaluation Score 2 (CAES-2), Pediatric Respiratory Assessment Measure (PRAM) and respiratory rate, accessory muscle use, decreased breath sounds (RAD).ResultsA total of 1120 observations were used to assess fourteen measurement properties within domains of validity, reliability and utility. All five dyspnoea scores showed overall poor results, scoring insufficiently on more than half of the quality criteria for measurement properties. The AS and PRAM were the most valid with good values on six and moderate values on three properties. Poor results were mainly due to insufficient measurement properties in the validity and reliability domains whereas utility properties were moderate to good in all scores.ConclusionThis study shows that commonly used dyspnoea scores show insufficient validity and reliability to allow for clinical use without caution.

Interobserver Agreement on Clinical Judgment of Work of Breathing in Spontaneously Breathing Children in the Pediatric Intensive Care Unit

“…Given the high number of clinical judgments of the WOB in children that PICU clinicians make on a day-to-day basis, it is quite disturbing that the interobserver agreement on rating the overall WOB in our study was low. Similar findings have previously been reported for subjectively assessing the severity of acute dyspnea in children with wheezing conditions such as asthma 12,13 and postextubation upper airway obstruction. 14 Apparently, even in a setting with clinicians highly specialized in pediatric acute pulmonary medicine, such as the PICU in our study, there is large variability in judgment of the degree of respiratory distress.…”

Population Pharmacokinetics of Intravenous Salbutamol in Children with Refractory Status Asthmaticus

“…As a PD parameter, the Qureshi asthma score was collected at the same time points as blood sampling. This validated score is routinely used in the intensive care unit to monitor symptom progression [12,13]. It is a 5-item scale (breathing frequency [categories for age], oxygen saturation, auscultation, retractions and dyspnea), with a minimum of 1 and maximum of 3 for each item, resulting in a range of 5-15.…”

Guideline on management of the acute asthma attack in children by Italian Society of Pediatrics

“…However, the value of pulmonary function parameters in the assessment of patients with respiratory distress is modest [ 4 – 15 ]. Only three high quality studies are available [ 11 – 13 ]. One is a systematic review of 60 studies showing that none of the available score are validated in the clinical practice [ 11 ].…”