Forno et al reported the Asthma Exacerbation Clinical Score for predicting asthma exacerbatons in children. This can help to identify a child at increased risk who may benefit from more aggresive management. The authors are from Brigham and Women's Hospital, Boston Children's Hospital and Hospital Nacional de Ninos in Costa Rica..
Patient selection: age 5 to 12 years with asthma
Outcome: acute exacerbation
Parameters:
(1) number of months per year with symptoms
(2) symptoms precipitated by colds
(3) symptoms precipitated by cold
(4) symptoms exacerbated by exercise
(5) symptoms exacerbated by dust
(6) currently receiving short-acting beta-2 agonist
(7) currently receiving inhaled steroids
(8) currently receiving leukotriene inhibitors
(9) ever hospitalized for asthma
(10) ever admitted to ICU for asthma
(11) number of courses of steroids in past year
(12) number of ER visits for asthma in past year
(13) number of doctor visits in past year
(14) personal history of eczema or hay fever
(15) parental history of asthma or atopy
(16) smoke exposure as infant or currently
|
Parameter |
Finding |
Points |
|
number of months with symptoms |
< 3 months |
0 |
|
|
>= 3 months |
1 |
|
symptoms precipitated by colds |
no |
0 |
|
|
yes |
1 |
|
symptoms precipitated by cold |
no |
0 |
|
|
yes |
1 |
|
symptoms exacerbated by exercise |
no |
0 |
|
|
yes |
1 |
|
symptoms exacerbated by dust |
no |
0 |
|
|
yes |
1 |
|
current short-acting beta-2 agonists |
no |
0 |
|
|
yes |
1 |
|
current inhaled steroids |
no |
0 |
|
|
yes |
1 |
|
current leukotriene inhibitors |
no |
0 |
|
|
yes |
1 |
|
ever hospitalized for asthma |
no |
0 |
|
|
yes |
1 |
|
ever admitted to ICU for asthma |
no |
0 |
|
|
yes |
1 |
|
number of courses with steroids in past year |
0 or 1 |
0 |
|
|
>= 2 |
1 |
|
number of ER visits for asthma in past year |
0 or 1 |
0 |
|
|
>= 2 |
1 |
|
doctor visits in past year |
0 to 2 |
0 |
|
|
3 to 5 |
1 |
|
|
>= 6 |
2 |
|
personal history of eczema or hay fever |
no |
0 |
|
|
yes |
1 |
|
parental history of asthma or atopy |
no |
0 |
|
|
yes |
1 |
|
smoke exposure as infant or currently |
no |
0 |
|
|
yes |
1 |
total score =
= SUM(points for all 16 parameters)
Interpretation:
• minimum score: 0
• maximum score: 17
• The higher the score the greater the risk of an asthma exacerbation.
|
Score |
Exacerbation Risk |
|
0 to 5 |
low |
|
6 to 8 |
moderate |
|
9 to 17 |
high |
Performance:
• The area under the ROC curve is 0.78.
Specialty: Pulmonology, Pedatrics, Emergency Medicine
