Stevens et al developed a simple score for screening pediatric patients coming to the Emergency Department for an acute asthmatic attack. The authors are from the Medical College of Wisconsin and the Children's Hospital of Wisconsin.
Patient selection: pediatric patients presenting with an asthmatic attack in the Emergency Department (ED)
Poor short-term outcome defined as one or more of the following during next 14 days:
(1) missed >= 5 days of school or daycare
(2) caretaker missed work or school >= 5 days
(3) unscheduled care
(4) hospital admission
(5) asthma symptoms above baseline at 14 days
Parameters:
(1) number of days with wheezing before coming to the ED
(2) number of acute outpatient asthma visits in past 12 months
(3) use of albuterol at home
(4) history of severe persistent asthma
(5) fever in the ED
|
Parameter |
Finding |
Points |
|
number of days wheezing |
< 2 |
0 |
|
|
>= 2 |
1 |
|
number of acute outpatient visits |
<= 2 |
0 |
|
|
>= 3 |
1 |
|
use of albuterol at home |
no |
0 |
|
|
yes |
1 |
|
history of severe persistent asthma |
no |
0 |
|
|
yes |
1 |
|
fever in the ED |
no |
0 |
|
|
yes |
1 |
total risk score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum risk score: 0
• maximum risk score: 5
• A score >= 2 indicated a group at high risk for poor short-term outcome.
Performance and Limitations:
• The sensitivity was 62-67% and specificity 61-68%. The Youden index is the pits.
• The test might have some use when the prevalence of patients likely to have a poor outcome is already high, as is seen in the Emergency Department.
Specialty: Pulmonology
