The Pediatric Predictive Index (PPI) can be used to evaluate a child presenting to the Emergency Department with acute asthma. It compares findings before and after initial management. The authors are from the University of Cincinnati.
Parameters:
(1) pretreatment inspiratory breath sounds
(2) post-treatment wheezing
(3) difference between respiratory rates before and after treatments (with a decrease in rate entered as a negative number)
difference between respiratory rates in breaths per minute =
= (respiratory rate after treatment) – (respiratory rate before treatment)
|
Parameter |
Finding |
Points |
|
pretreatment inspiratory breath sounds |
increased |
0 |
|
|
normal |
0 |
|
|
decreased |
1 |
|
post-treatment wheezing |
none |
0 |
|
|
mild |
0 |
|
|
moderate |
2 |
|
|
severe |
2 |
|
difference in respiratory rate |
|
0.2 * (difference) |
PPI =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: determined by difference in rates; may be -3.0
• maximum score: determined by difference in rates; may be 5.0 or higher
• A high score suggests continued or worsening symptoms after treatment.
|
Performance at different cutoff points (relative to admission) |
Sensitivity (correctly categorized admission) |
Specificity (incorrectly categorized discharge) |
|
> 0 |
95% |
34% |
|
> 1 |
80% |
18% |
|
> 2 |
50% |
9% |
|
> 2.5 |
45% |
5% |
Limitations:
• I am a little confused by how sensitivity and specificity are defined.
• The score does not identify children who relapse.
Specialty: Pulmonology
