Prediction of asthma admission using the newly developed Siriraj clinical asthma score (SCAS) compared to Wood's and Parkin's score

Abstract

Rationale Since the assessment of acute asthma severity with previously developed asthma score results in a significant interpersonal variation, we developed SCAS for prediction of hospitalization compared to Wood's and Parkin's score. Methods Asthmatic patients under 12 years of age presented to the emergency room or out patient department (OPD), with acute asthmatic attack were enrolled. SCAS assessing wheezing, respiratory rate, chest retraction, dyspnea and oxygen saturation in room air were recorded along with Wood's and Parkin's score before and after each bronchodilator nebulization until the patients were discharged or admitted to the hospital. Results Seventy patients were enrolled. Fourteen percent of them were admitted with SCAS ≥9, Wood's score ≥6, Parkin's score ≥8. Wood's score have high accuracy at ≥6, high specificity at ≥7. Parkin's score have high accuracy at ≥8 high specificity at ≥9, SCAS have high accuracy at ≥9 high specificity at ≥10. All of the items have a good interpersonal reliability except I:E ratio (weighted kappa (Kw)=0.28, 95%CI=0.01,0.54), Air entry (Kw=0.78, 95%CI=0.49,1.00) and breath sounds (Kw=0.63, 95%CI=0.34,0.91). All items except conscious change, cyanosis and I:E ratio were correlated well with nebulization used (P-value<0.01). For intraclass correlation, SCAS have a highest value (1). Conclusions SCAS score have a good predictability of asthma admission with a good interpersonal reliability. Score's value have a good validity of a prediction of nebulization used.