Interrater Reliability of the Pediatric Asthma Score

Abstract

Objectives:The aim of this study was to determine the interrater reliability (IRR) of the Pediatric Asthma Score (PAS) and to evaluate the discriminative performance of this score to predict the need for hospital admission among children with acute asthma. Methods:A secondary analysis of prospective data was performed to compare triage nurse and study personnel PAS scores among children aged 6 to 18 years presenting to the emergency department with acute asthma. The IRR was determined by calculation of weighted Cohen κ with differences evaluated by Wilcoxon ranked pairs. Receiver operating characteristic curves were created to evaluate the predictive ability of PAS to determine the need for hospital admission.Results: One hundred one subjects were evaluated by both study personnel and a triage nurse with PAS score recorded. The IRR of the total PAS score was determined to be moderate (κ = 0.57) and acceptable, although lower than previously reported. Individual components of the PAS score demonstrated fair to substantial agreement. Receiver operating characteristic analysis demonstrated total PAS at emergency department triage to have poor test characteristics in predicting the need for hospital admission, whether PAS was determined by study personnel, triage nurse, or an average score (area under the curve, 0.62-0.65). Conclusions:In this study, total PAS score demonstrated a moderate and acceptable level of IRR with a poor discriminative ability to determine the need for hospital admission at the time of ED triage.

Pleural line slope in point of care ultrasound assessment of paediatric wheeze may reflect respiratory effort

“…Severity of paediatric lower airway obstruction can be measured by scoring systems such as the paediatric asthma score and the Paediatric Respiratory Assessment Measure, 1,2 which rely on physical examination‐based measures such as retractions and degree of dyspnea. These scores have moderate interrater reliability and an inability to predict hospital admission 3 …”

“…These scores have moderate interrater reliability and an inability to predict hospital admission. 3 POCUS has improved diagnostic accuracy compared with auscultation of cardiac function, 4 bowel motility 5 and pneumonia. 6 Here, we present a novel approach to viewing lower airway obstruction by recording movement at the pleural line.We show that pleural line slope and excursion are different with and without lower airway obstruction and that pleural line movement can be quantified to correlate with admission to the hospital.…”

“…These scores have moderate interrater reliability and an inability to predict hospital admission. 3 POCUS has improved diagnostic accuracy compared with auscultation of cardiac function, 4 bowel motility 5 and pneumonia. 6 Here, we present a novel approach to viewing lower airway obstruction by recording movement at the pleural line.…”