Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2025 Apr;60(4):e71084.
doi: 10.1002/ppul.71084.

Performance of the Asthma Clinical Score in the Evaluation of Acute Asthma in the Emergency Department

Adjoa A Andoh  1   2 , Annie Truelove  1   3 , Sara Helwig  1   3 , Matthew C Nash  1   3 , Lisa Ulrich  2   4 , Richard Shell  2   4 , Julie C Leonard  1   2   3
Affiliations
Observational Study

Performance of the Asthma Clinical Score in the Evaluation of Acute Asthma in the Emergency Department

Adjoa A Andoh et al. Pediatr Pulmonol. 2025 Apr.

Abstract

Objective: The primary objective of this study was to examine the performance of the Asthma Clinical Score (ACS) relative to the Pediatric Respiratory Assessment Measure (PRAM). Our secondary objectives were to determine interrater reliability, discriminative validity, responsiveness, and predictive validity of the ACS and PRAM.

Methods: This was a single-site prospective observational study of children ages 2 to < 18 years presenting to the emergency department (ED) for asthma exacerbations. Clinicians completed paired assessments using ACS and PRAM at three time points of each patients ED stay. Construct validity correlating the performance of the ACS to PRAM, and interrater reliability were analyzed using Spearmen's rank correlation coefficients and Cohen's kappa coefficient, respectively. Cohen's d was calculated to compare the scores of patients who received certain treatments to patients who did not. Reliable change index (RCI) was used to determine the responsiveness of each score. Predictive validity for hospitalization was analyzed using Area Under the Receiver Operating Characteristic curve (AUROCc) and Akaike Information Criterion (AIC).

Results: 399 children were enrolled with 338 paired clinician observations. The ACS and PRAM scores were strongly correlated at all time points (n = 1383, ρ $\rho $ = 0.874). Both the ACS and PRAM showed moderate interrater reliability at all time points (n = 338, κw = 0.77 and κw = 0.69, respectively). Patients receiving albuterol nebulization or adjunctive medications had higher average ACS and PRAM scores. ACS showed a better ability to detect responsiveness than the PRAM (31% vs 15% respectively). The pretreatment ACS showed comparable predictive validity to the PRAM.

Conclusion: The ACS was highly correlated with PRAM and is a reliable score in this cohort. The ACS showed good discriminative validity, predictive validity and responsiveness. This study supports the ACS as a useful tool in ED assessment of asthma exacerbation severity in children.

Keywords: assessment; exacerbations; reliability; scores; validation.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

Figures

Figure 1
Figure 1
(a) Components of the Asthma Clinical Score. (b) Components of the Pediatric Respiratory Assessment Measure.
Figure 2
Figure 2
Assessment of the strength of correlation (construct validity) between the Asthma Clinical Score and Pediatric Respiratory Assessment Measure at each timepoint.* ρ= Spearman correlation coefficient between the Asthma Clinical Score and Pediatric Respiratory Assessment Measure. Dark greyscales indicate increased number of observations at each point. Abbreviation: ACS = Asthma Clinical Score, PRAM = Pediatric Respiratory Assessment Measure, CI = confidence intervals.
Figure 3
Figure 3
Predictive validity of the ACS and the PRAM. Abbreviation: ACS = Asthma Clinical Score, PRAM = Pediatric Respiratory Assessment Measure, Pre = pretreatment score.
See this image and copyright information in PMC

References

    1. Zahran H. S., Bailey C. M., Damon S. A., Garbe P. L., and Breysse P. N., “Vital Signs: Asthma in Children — United States, 2001–2016,” MMWR. Morbidity and Mortality Weekly Report 67, no. 5 (2018): 149–155. - PMC - PubMed
    1. Healthcare Cost and Utilization Project, National (Nationwide) Emergency Department Sample (NEDS) . NEDS Database Documentation. March 29, 2023, accessed December 12, 2024, https://hcup-us.ahrq.gov/db/nation/neds/nedsdbdocumentation.jsp.
    1. Pardue Jones B., Fleming G. M., Otillio J. K., Asokan I., and Arnold D. H., “Pediatric Acute Asthma Exacerbations: Evaluation and Management From Emergency Department to Intensive Care Unit,” Journal of Asthma 53, no. 6 (2016): 607–617. - PubMed
    1. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma . National Asthma Education and Prevention Program, Third Expert Panel on the Diagnosis and Management of Asthma. Bethesda (MD): National Heart, Lung, and Blood Institute (US); 2007. Aug, https://www.ncbi.nlm.nih.gov/books/NBK7232/.
    1. Gorelick M. H., Stevens M. W., Schultz T., and Scribano P. V., “Difficulty in Obtaining Peak Expiratory Flow Measurements in Children With Acute Asthma,” Pediatric Emergency Care 20, no. 1 (2004): 22–26. - PubMed

Publication types