Parkin et al developed a clinical score that can be used to evaluate the clinical severity of asthma in children from 1 to 5 years of age who require hospitalization. This can be used to initially evaluate the child and to monitor the response to therapy. The authors are from the Hospital for Sick Children in Toronto.
Patient population: children hospitalized for asthma, ranging in age from 1 to 5 years of age
Parameters:
(1) respiratory rate
(2) wheezing as detected using a stethoscope
(3) indrawing
(4) degree of apparent dyspnea based on clinical observation
(5) ratio of inspiratory-to-respiratory cycles
|
Parameter |
Finding |
Points |
|
respiratory rate |
< 40 breaths per minute |
0 |
|
|
40 – 60 breaths per minute |
1 |
|
|
> 60 breaths per minute |
2 |
|
wheezing using a stethoscope |
none |
0 |
|
|
on expiration only |
1 |
|
|
during both inspiration and expiration |
2 |
|
indrawing |
none |
0 |
|
|
subcostal only |
1 |
|
|
subcostal and intercostal |
2 |
|
apparent dyspnea |
none |
0 |
|
|
mild |
1 |
|
|
marked |
2 |
|
inspiration vs expiration |
inspiration > expiration |
0 |
|
|
inspiration = expiration |
1 |
|
|
inspiration < expiration |
2 |
clinical score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 10
• The higher the score, the greater the clinical impact of the asthma. A child requiring hospitalization for asthma should not have a low score at the time of admission.
• With effective management the clinical score should decline over the hospitalization.
Performance:
• Interobserver reliability: weighted kappa 0.82 to 0.89
• Construct validity: Spearman's rank correlation coefficient 0.47
• Discriminatory power: Ferguson's delta 0.92
• Responsive to change between admission and discharge using the Wilcoxon signed rank test.
Specialty: Pulmonology
