Pediatric asthma severity scores distinguish suitable inpatient level of care for children admitted for status asthmaticus

Ryan, Kelsey; Son, Sorany; Roddy, Meghan; Siraj, Shaila; McKinley, Scott; Nakagawa, Thomas A.; Sochet, Anthony A.

doi:10.1080/02770903.2019.1680998

Cited by 9 publications

(16 citation statements)

References 24 publications

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“…A score with poor reliability may lead to false assumptions regarding patient condition and could result in errors regarding patient disposition. The respiratory distress assessment instrument (RDAI) described by Lowell et al, reveal excellent clinical responsiveness as values correlate with response to racemic epinephrine administration 21 . However, RDAI has poor construct validity and considerable test‐retest measurement error 22 .…”

Section: Discussionmentioning

confidence: 99%

“…The respiratory distress assessment instrument (RDAI) described by Lowell et al, reveal excellent clinical responsiveness as values correlate with response to racemic epinephrine administration. 21 However, RDAI has poor construct validity and considerable test-retest measurement error. 22 This highlights how a clinical score may perform well in one domain without necessarily translating to performance in others.…”

Section: Construct Validitymentioning

confidence: 99%

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The bronchiolitis severity score: An assessment of face validity, construct validity, and interobserver reliability

Siraj

Stark

McKinley

et al. 2021

Pediatric Pulmonology

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Objective: To assess face validity, interobserver reliability, and the ability to discriminate escalations of care within 24-h of admission (late rescues) for the bronchiolitis severity score (BSS) for children hospitalized for acute bronchiolitis.Hypotheses: The BSS will yield variable face validity, have clinically relevant interobserver reliability (kappa > 0.7), and distinguish late rescues during hospitalization.Methods: We performed a combined retrospective and prospective, mixed methods study where (1) interobserver agreement was prospectively assessed by overall and subcategory congruence (kappa) calculations, (2) face value were qualitatively assessed from aggregate questionnaire responses, and (3) construct validity for late rescues were assessed using receiver operator characteristic (ROC) curve analyses.Results: Face validity, assessed from 39 questionnaire respondents, were generally positive for BSS utility, reliability, and usability. The BSS exhibited weak interobserver reliability (kappa = 0.22, 95% confidence interval [CI]: 0.11-0.31) calculated from 72 sequential, blinded calculations. Retrospectively, 181 children less than 2 years of age admitted to the general pediatric ward for acute bronchiolitis from November 2017 to April 2019 were identified of which 18 (9.9%) experienced late rescues. Admission BSS values were no different for children with and without late rescues (6[3,6] vs. 4[3,6]; p = .09). An ROC curve analysis revealed an area under the curve of 0.61 (95% CI: 0.48-0.75; threshold ≥6 with sensitivity = 56%, specificity = 69%) for BSS to discriminate late rescues. Conclusion:Although clinicians expressed favorable perceptions of BSS face and content validity, we noted weak interobserver reliability and limited construct validity. Further development and validation are needed to strengthen the BSS before routine use.

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Section: Discussionmentioning

confidence: 99%

Section: Construct Validitymentioning

confidence: 99%

The bronchiolitis severity score: An assessment of face validity, construct validity, and interobserver reliability

Siraj

Stark

McKinley

et al. 2021

Pediatric Pulmonology

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“…27 While the randomized methodology should be applauded, these studies included young children unconfirmed asthma, assessed non-equivalent heliox concentrations, and used dyspnea scores known to have poor reliability and validity for pediatric CA. 28,29…”

Section: Discussionmentioning

confidence: 99%

Heliox for Pediatric Critical Asthma: A Multicenter, Retrospective, Registry-Based Descriptive Study

Lew

Morrison

Amankwah

et al. 2021

J Intensive Care Med

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Background: In cases of critical asthma (CA), heliox may be applied as an adjunctive rescue therapy to avoid invasive mechanical ventilation (MV), improve deposition of aerosolized medications, and enhance laminar airflow through obstructed airways. Using the Pediatric Health Information System (PHIS) registry, we evaluate heliox prescribing and explored for differences in MV rates and hospital length of stay (LOS) among children with and without heliox exposure. Methods: We performed a retrospective cohort study using PHIS data from 42 pediatric intensive care units among children 5-17 years of age admitted for CA from 2010 through 2019. Primary outcomes were heliox prescribing rates and trends. Secondary outcomes were invasive MV rates and LOS assessed in a subgroup of children receiving ≥ 1 adjunctive intervention(s). Results: Of the 19,780 studied, heliox was prescribed in 12.5% and linearly declined from 16.1% in 2010 to 5.6% in 2019. The overall MV rate was 12.8% and was lower in subjects receiving heliox alone (4.9%) compared to heliox plus alternative adjunctive therapies [31.2%] or children receiving non-heliox adjunctive therapies [22.1%], P < .01). Accounting for MV, no difference in LOS was observed. In exploratory adjusted models, MV free hospitalization was associated with heliox-only exposure (OR: 0.33, 95% CI: 0.17-0.63, P < .01) and exposure to multiple adjunctive therapies was associated with MV (OR: 2.48, 95% CI: 1.56-3.94, P < .01). Conclusions: In this multicenter retrospective study from 42 children’s hospitals, heliox prescribing for CA declined over the last decade. Subjects receiving multiple adjunctive therapies more commonly required invasive MV perhaps indicating a greater severity of illness. At this time, prospective trials needed to identify the role of heliox for pediatric CA.

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“…8,26,27 Some tools can also predict the need for admission and level of inpatient care. 25,[28][29][30][31] Several institutions have developed asthma treatment pathways based on scoring tools to improve care through standardization. 32,33…”

Section: Scoring Tools and Disease Severitymentioning

confidence: 99%

“…Asthma severity scoring tools have been associated with more timely administration of medications, reductions in ED length of stay, and reductions in admissions without a corresponding increase in return ED visits 8,26,27 . Some tools can also predict the need for admission and level of inpatient care 25,28–31 . Several institutions have developed asthma treatment pathways based on scoring tools to improve care through standardization 32,33…”

Section: Scoring Tools and Disease Severitymentioning

confidence: 99%

Emergency department treatment of asthma in children: A review

et al. 2020

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Pediatric asthma severity scores distinguish suitable inpatient level of care for children admitted for status asthmaticus

Cited by 9 publications

References 24 publications

The bronchiolitis severity score: An assessment of face validity, construct validity, and interobserver reliability

The bronchiolitis severity score: An assessment of face validity, construct validity, and interobserver reliability

Heliox for Pediatric Critical Asthma: A Multicenter, Retrospective, Registry-Based Descriptive Study

Emergency department treatment of asthma in children: A review

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