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Research ArticleOriginal Research

Comparison of Two Assessment Tools for Hospitalized Subjects With Asthma

Sangeeta K Schroeder, Waheeda Samady, Irini N Kolaitis, Craig M Smith, Hannah Palac, Laura Shreffler and Mary A Nevin
Respiratory Care January 2021, 66 (1) 104-112; DOI: https://doi.org/10.4187/respcare.07761
Sangeeta K Schroeder
Northwestern University Feinberg School of Medicine, Chicago, Illinois and Ann and Robert H. Lurie Children's Hospital of Chicago.
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Waheeda Samady
Northwestern University Feinberg School of Medicine, Chicago, Illinois and Ann and Robert H. Lurie Children's Hospital of Chicago.
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  • For correspondence: [email protected]
Irini N Kolaitis
Northwestern University Feinberg School of Medicine, Chicago, Illinois and Ann and Robert H. Lurie Children's Hospital of Chicago.
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Craig M Smith
Northwestern University Feinberg School of Medicine, Chicago, Illinois and Ann and Robert H. Lurie Children's Hospital of Chicago.
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Hannah Palac
Northwestern University Feinberg School of Medicine, Chicago, Illinois and Ann and Robert H. Lurie Children's Hospital of Chicago.
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Laura Shreffler
Ann and Robert H Lurie Children's Hospital of Chicago, Chicago, Illinois.
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Mary A Nevin
Northwestern University Feinberg School of Medicine, Chicago, Illinois and Ann and Robert H. Lurie Children's Hospital of Chicago.
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Abstract

BACKGROUND: Pediatric Asthma Assessment tools used to guide the weaning of inhaled therapies during inpatient hospitalization require further evaluation and validation. This study aimed to compare 2 asthma assessment tools: an asthma scale versus an asthma score.

METHODS: A prospective, physician-blinded, comparison study was conducted in 2 separate 6-week phases of patients > 2 y old admitted to a tertiary care children's hospital with status asthmaticus between July and November 2014. The asthma scale categorized 5 components (oxygen, auscultation, dyspnea, breathing frequency, and pulse oximetry) into 1 of 3 respiratory assessments: mild, moderate, or severe. The asthma score used a sum of the components, resulting in a score of 1–15. Study tool predictability was measured using a metric based on hours on continuous albuterol, with area under the curve ≥ 0.8 indicating good predictability. Agreement between clinicians was measured using the Cohen kappa statistic. Study tool clinical correlation was measured using Spearman coefficient. Usability was evaluated using web-based surveys.

RESULTS: Phase 1 included 1,971 assessments (97 unique subjects), whereas phase 2 included 607 assessments (69 unique subjects). Using the continuous albuterol metric, predictability of the asthma scale had an area under the curve of 0.62 versus the asthma score area under the curve of 0.80. Agreement early in hospitalization for the asthma scale was kappa = 0.34 (95% CI 0.18–0.5; n = 84) versus kappa = 0.55 (95% CI 0.35–0.76; n = 44) for the asthma score. Agreement late in hospitalization for the asthma scale was kappa = 0.38 (95% CI 0.17–0.59; n = 66) versus kappa = 0.41 (95% CI 0.13–0.69; n = 33) for the asthma score. Clinical correlation for the asthma scale (no. = 1,908) was r = 0.57 (P < .001) versus r = 0.80 (P < .001) for the asthma score (no. = 558). Mean asthma scale usability was 3.38 versus 3.68 for the asthma score.

CONCLUSIONS: The asthma score showed better clinical predictability and clinical correlation compared to the asthma scale. Numerical scores provided more objective assessments compared to categorical scores. Validated scoring tools such as the asthma score are crucial to the success of management of inpatient asthma care.

  • asthma
  • assessment tools
  • in-patient
  • pediatric
  • respiratory therapist
  • nurses

Footnotes

  • Correspondence: Waheeda Samady MD MSCI. E-mail: wsamady{at}luriechildrens.org
  • Copyright © 2021 by Daedalus Enterprises
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Respiratory Care: 66 (1)
Respiratory Care
Vol. 66, Issue 1
1 Jan 2021
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Comparison of Two Assessment Tools for Hospitalized Subjects With Asthma
Sangeeta K Schroeder, Waheeda Samady, Irini N Kolaitis, Craig M Smith, Hannah Palac, Laura Shreffler, Mary A Nevin
Respiratory Care Jan 2021, 66 (1) 104-112; DOI: 10.4187/respcare.07761

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Comparison of Two Assessment Tools for Hospitalized Subjects With Asthma
Sangeeta K Schroeder, Waheeda Samady, Irini N Kolaitis, Craig M Smith, Hannah Palac, Laura Shreffler, Mary A Nevin
Respiratory Care Jan 2021, 66 (1) 104-112; DOI: 10.4187/respcare.07761
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Keywords

  • asthma
  • assessment tools
  • in-patient
  • pediatric
  • respiratory therapist
  • nurses

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