Blumer et al developed a clinical efficacy score to evaluate pediatric patients with cystic fibrosis. This can be used to monitor a child's response to therapy. The authors are from Rainbow Babies and Children's Hospital and Case Western ReserveUniversity in Cleveland, Ohio.
Patient selection: pediatric patient >= 5 years of age
Parameters:
(1) percent change in sputum volume
(2) respiratory rate while sleeping in breaths per minute
(3) chest physical exam, rales
(4) chest physical exam, air exchange
(5) carbon dioxide "tension" (carbon dioxide tension refers to PCO2 in mm Hg but usage suggests total CO2 in mmol/L)
(6) FEV1 as percent of expected
(7) exercise tolerance on exercycle
(8) number of days with normal temperature in past week
(9) weight gain or loss in kilograms
(10) oxygen saturation in percent
(11) ventilatory capacity as percent of expected
Rales and air exchange were based on features seen:
(1) superior, middle and inferior regions (3)
(2) left and right (2)
(3) anterior and posterior (2)
Total location readings = 3 * 2 * 2 = 12
points for rales =
= 12 - (number of location readings with rales)
points for air exchange =
= (2 * (number of location readings with good air exchange)) + (number of location readings with fair air exchange)
exercise tolerance =
= MIN(15, minutes of exercise)
|
Parameter |
Finding |
Points |
|---|---|---|
|
percent change in sputum volume |
increased 51 to 100% |
0 |
|
|
increased 10 to 50% |
1 |
|
|
unchanged |
3 |
|
|
decreased 10 to 50% |
4 |
|
|
decreased 51 to 100% |
5 |
|
respiratory rate when asleep |
12-16 breaths per minute |
5 |
|
|
17-22 |
4 |
|
|
23-28 |
3 |
|
|
29-34 |
2 |
|
|
>= 35 |
1 |
|
carbon dioxide tension |
20-25 |
5 |
|
|
26-30 |
4 |
|
|
31-35 |
3 |
|
|
36-40 |
2 |
|
|
41-45 |
1 |
|
|
> 45 |
0 |
|
FEV1 as percent of expected |
90-100% |
10 |
|
|
80-89% |
8 |
|
|
70-79% |
6 |
|
|
60-69% |
4 |
|
|
50-59% |
2 |
|
|
< 50% |
0 |
|
number of days with normal temperature in past week |
6 or 7 |
5 |
|
|
5 or 5 |
4 |
|
|
4 or 5 |
3 |
|
|
3 or 4 |
2 |
|
|
0 to 2 |
0 |
|
weight change |
gain >= 2.6 kg |
4 |
|
|
gain 0.5 to 2.5 kg |
3 |
|
|
unchanged |
2 |
|
|
loss 0.5 to 2.5 kg |
1 |
|
|
loss >= 2.6 kg |
0 |
|
oxygen saturation |
90-100% |
5 |
|
|
80-89% |
4 |
|
|
70-79% |
3 |
|
|
60-69% |
2 |
|
|
50-59% |
1 |
|
|
< 50% |
0 |
|
ventilatory capacity as percent of expected |
90-100% |
10 |
|
|
80-89% |
8 |
|
|
70-79% |
6 |
|
|
60-69% |
4 |
|
|
50-59% |
2 |
|
|
< 50% |
0 |
total score =
= SUM(points for all 11 parameters)
Interpretation:
• minimum total score: 1
• maximum total score: 100
• The higher the score the more normal the patient.
Specialty: Pulmonology, Genetics, Gastroenterology
ICD-10: ,
