The Journal of Pediatrics
Volume 152, Issue 4 , Pages 476-480.e1 , April 2008

The Pediatric Respiratory Assessment Measure: A Valid Clinical Score for Assessing Acute Asthma Severity from Toddlers to Teenagers

  • Francine M. Ducharme, MD, MSc

      Affiliations

    • Clinical Research Group on Childhood Asthma, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
    • Corresponding Author InformationReprint requests: Dr Francine Ducharme, Department of Pediatrics, Montreal Children’s Hospital of McGill University Health Centre, 2300 Tupper Street, Montréal, Québec, Canada, H3H 1P3.
  • ,
  • Dominic Chalut, MD

      Affiliations

    • Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital of McGill University Health Centre, Montreal, Quebec, Canada
  • ,
  • Laurie Plotnick, MD

      Affiliations

    • Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital of McGill University Health Centre, Montreal, Quebec, Canada
  • ,
  • Cheryl Savdie, MSc

      Affiliations

    • Clinical Research Group on Childhood Asthma, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
  • ,
  • Denise Kudirka, RN

      Affiliations

    • Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital of McGill University Health Centre, Montreal, Quebec, Canada
  • ,
  • Xun Zhang, PhD

      Affiliations

    • Service of Biostatistics, Montreal Children’s Hospital Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.
  • ,
  • Linyan Meng, MSc

      Affiliations

    • Clinical Research Group on Childhood Asthma, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
  • ,
  • David McGillivray, MD

      Affiliations

    • Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital of McGill University Health Centre, Montreal, Quebec, Canada

Received 15 March 2007 ,Revised 4 June 2007 ,Accepted 17 August 2007.

References 

  1. National Institutes of Health. Global strategy for asthma management and prevention NIH publication no 02-3659. www.ginasthma.org[updated 2005]
  2. Ducharme FM, Davis GM. Measurement of respiratory resistance in the emergency department: feasibility in young children with acute asthma. Chest. 1997;111:1519–1525
  3. Stevens MW, Gorelick MH. Short-term outcomes after acute treatment of pediatric asthma. Pediatr. 2001;107:1357–1362
  4. Gorelick MH, Stevens MW, Schultz TR, Scribano PV. Performance of a novel clinical score, the Pediatric Asthma Severity Score (PASS), in the evaluation of acute asthma. Acad Emerg Med. 2004;11:10–18
  5. Canny GJ, Reisman J, Healy R, Schwartz C, Petrou C, Rebuck AS, et al. Acute asthma: observations regarding the management of a pediatric emergency room. Pediatrics. 1989;83:507–512
  6. van der Windt DA, Nagelkerke AF, Bouter LM, Dankert-Roelse JE, Veerman AJ. Clinical scores for acute asthma in pre-school children (A review of the literature). J Clin Epidemiol. 1994;47:635–646
  7. van der Windt DA. Promises and pitfalls in the evaluation of pediatric asthma scores. J Pediatr. 2000;137:744–746
  8. Becker AB, Nelson NA, Simons ER. The Pulmonary Index: Assessment of a Clinical Score for Asthma. Am J Dis Child. 1984;138:574–576
  9. Smith SR, Baty JD, Hodge D. Validation of the pulmonary score: an asthma severity score for children. Acad Emerg Med. 2002;9:99–104
  10. Birken CS, Parkin PC, Macarthur C. Asthma severity scores for preschoolers displayed weaknesses in reliability, validity, and responsiveness. J Clin Epidemiol. 2004;57:1177–1181
  11. Chalut DS, Ducharme FM, Davis GM. The preschool respiratory assessment measure (PRAM): A responsive index of acute asthma severity. J Pediatr. 2000;137:762–768
  12. Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika. 1951;16:297–334
  13. Trochim WM. The Research Methods Knowledge Base [homepage on the Internet]. 2nd ed. [updated 2006 October 20; cited 2007 May 30] http://www.socialresearchmethods.net/kb/measval.phpMeasurement validity types
  14. Guyatt GH, Kirshner B, Jaeschke R. A methodologic framework for health status measures: Clarity or oversimplification?. J Clin Epidemiol. 1992;45:1353–1355
  15. Guyatt G, Walter S, Norman G. Measuring change over time: Assessing the usefulness of evaluative instruments. J Chron Dis. 1987;40:171–178
  16. Husted JA, Cook RJ, Farewell VT, Gladman DD. Methods for assessing responsiveness: A critical review and recommendations. J Clin Epidemiol. 2000;53:459–468
  17. Kazis LE, Anderson JJ, Meenan RF. Effect sizes for interpreting changes in health status. Med Care. 1989;27:89;Suppl
  18. Cohen J. Weighted kappa: nominal scale agreement with provision for scaled disagreement or partial credit. Psychol Bull. 1968;70:213–222
  19. Godfrey S, Edwards RHT, Campbell EJM, Armitage P, Oppenheimer EA. Repeatability of physical signs in airways obstruction. Thorax. 1969;24:4–9
  20. Mower WR, Sachs C, Nicklin EL, Baraff LJ. Pulse oximetry as a fifth pediatric vital sign. Pediatrics. 1997;99:681–686
  21. Geelhoed GC, Landau LI, Le Souef PN. Evaluation of Sa02 as a predictor of outcome in 280 children presenting with acute asthma. Ann Emerg Med. 1994;23:1236–1241
  22. Geelhoed GC, Landau LI, LeSouef PN. Predictive value of oxygen saturation in emergency evaluation of asthmatic children. Br Med J. 1988;297:395–396
  23. Mehta SV, Parkin PC, Stephens D, Keogh KA, Schuh S. Oxygen saturation as a predictor of prolonged, frequent bronchodilator therapy in children with acute asthma. J Pediatr. 2004;145:641–645[erratum appears in J Pediatr. 2004;145(6):864]
  24. Kelly AM, Kerr D, Powell C. Is severity assessment after one hour of treatment better for predicting the need for admission in acute asthma?. Respir Med. 2004;98:777–781
  25. Schuh S, Johnson D, Stephens D, Callahan S, Canny G. Hospitalization patterns in severe acute asthma in children. Pediatr Pulmonol. 1997;23:184–192
  26. Rutjes AW, Reitsma JB, Di NM, Smidt N, van Rijn JC, Bossuyt PM. Evidence of bias and variation in diagnostic accuracy studies. CMAJ. 2006;174:469–476
  27. Harvey S, Forbes L, Jarvis D, Price J, Burney P. Accident and emergency departments are still failing to assess asthma severity. Br Med J. 2003;20:329–331
  28. Cabana MD, Bruckman D, Meister K, Bradley JF, Clark N. Documentation of asthma severity in pediatric outpatient clinics. Clin Pediatr. 2003;42:121–125
  29. Gorelick MH, Stevens MW, Schultz T, Scribano PV. Difficulty in obtaining peak expiratory flow measurements in children with acute asthma. Pediatr Emerg Care. 2004;20:22–26
  30. Rowe BH, Spooner C, Ducharme FM, Bretzlaff JA, Bota GW. Early emergency department treatment of acute asthma with systemic corticosteroids. Cochrane Database Syst Rev. 2001;1:CD002178
  31. Plotnick L, Ducharme FM. Should inhaled anticholinergics be added to beta2-agonists in acute pediatric asthma? (A systematic review of randomized controlled trials). Br Med J. 1998;317:971–977
  32. Cates CCJ, Bara A, Crilly JA, Rowe BH. Holding chambers versus nebulisers for beta-agonist treatment of acute asthma (Cochrane Review). In: The Cochrane Library Issue 3, Oxford: Update Software. 2003.

 Supported by a grant of the Research Institute of the McGill University Health Centre.

PII: S0022-3476(07)00786-X

doi: 10.1016/j.jpeds.2007.08.034

The Journal of Pediatrics
Volume 152, Issue 4 , Pages 476-480.e1 , April 2008