Pediatric Asthma Severity Score Research Articles

Validation of the Spanish version of the Pediatric Asthma Severity Score (PASS) in a population of Hispanic children.

The Pediatric Asthma Severity Score (PASS)is one of the most-used clinical scoring systems for assessing the severity of asthma exacerbations in children. The aim of the present study was to validate a Spanish version of the PASS in a population of Hispanic children with asthma exacerbations living in urban Bogota, Colombia. In a prospective cohort and a validation study, parents/caregivers of children between 2 and 18 years old attended in the emergency department (ED)with asthma exacerbations who were admitted to the inpatient unit were invited to participate in the study. During the hospitalization period, we gathered the necessary data for assessing the criterion validity (comparing its score with the Pediatric Respiratory Assessment Measure [PRAM]), construct validity, interrater reliability, responsiveness, and internal consistency of the Col-PASS,the Colombian version of the PASS. At baseline, the scores of the Col-PASScorrelated positively with the scores of the PRAMscore (ρ = 0.588, p < .001). The baseline Col-PASSscores in patients who required admission to a more complex service were significantly higher than those in patients who presented clinical improvement (1.0 (0.0-2.0) vs. 0.0 (0.0-0.0), p < .001). The interrater reliability was found to be κ = 0.897, 95% CI 0.699-1.000, p < .001. Cronbach's α was .701 for the questionnaire as a whole. The Col-PASShas excellent construct validity, adequate criterion validity, interrater reliability, responsiveness; and acceptable internal consistency when used in children between 2 and 18 years old with asthma exacerbations.

A pediatric hospital-wide asthma severity score: Reliability and effectiveness.

Asthma is a leading cause of pediatric hospitalization in the United States. Children hospitalized with asthma are often managed in different care settings during hospitalization, posing challenges to accurate communication among care providers about illness severity. Our objective was to study the feasibility, reliability, and safety of a new pediatric hospital-wide asthma severity score (HASS) across different care units within a single tertiary-care pediatric center. 150 patients between the ages of 2 and 18 years hospitalized with a principal diagnosis of status asthmaticus were included in this study. Study patients were followed from the time of initial triage in the emergency department until the time of medical readiness for discharge. Rates of medical errors, early transfers to a higher level of care and medically indicated hospital length of stay (LOS) were compared between 75 patients before and 75 patients after widespread implementation of the HASS using retrospective chart review and anonymous staff reporting. Interrater reliability was determined by collecting independent HASS scores from blinded staff members after tandem or simultaneous patient assessment. Interrater reliability among untrained staff members using the HASS was high. Hospital LOS, rates of adverse events, medical errors, and early transfer to a higher level of care were not significantly different before and after widespread HASS implementation. The HASS is a reliable asthma severity tool that can be used throughout hospitalization and among multiple clinical providers to trend clinical progress and optimize communication, particularly during times of care handoffs.

Single Nucleotide Polymorphisms (SNPs) in PRKG1 & SPATA13-AS1 are associated with bronchodilator response: a pilot study during acute asthma exacerbations in African American children.

Inhaled bronchodilators are the first-line treatment for asthma exacerbations, but individual bronchodilator response (BDR) varies by race and ethnicity. Studies have examined BDR's genetic underpinnings, but many did not include children or were not conducted during an asthma exacerbation. This pilot study tested single-nucleotide polymorphisms' (SNPs') association with pediatric African American BDR during an acute asthma exacerbation. This was a study of pediatric asthma patients in the age group 2-18 years treated in the emergency department for an asthma exacerbation. We measured BDR before and after inhaled bronchodilator treatments using both the Pediatric Asthma Severity Score (PASS) and asthma severity score. We collected genomic DNA and examined whether 21 candidate SNPs from a review of the literature were associated with BDR using crude odds ratios (OR) and adjusted analysis. The final sample population was 53 children, with an average age of 7.2 years. The average initial PASS score (scale of ascending severity from 0 to 6) was 2.5. After adjusting for BMI, age category, gender and smoke exposure, rs912142 was associated with decreased odds of having low BDR (OR, 0.20; 95% confidence interval (CI), 0.02-0.92), and rs7081864 and rs7903366 were associated with decreased odds of having high BDR (OR, 0.097; 95% CI, 0.009-0.62). We found three SNPs significantly associated with pediatric African American BDR that provide information regarding a child's potential response to emergency asthma exacerbation treatment. Once validated in larger studies, such information could guide pharmacogenomic evidence-based emergency asthma treatment to improve patient outcomes.

Methylprednisolone, dexamethasone or hydrocortisone for acute severe pediatric asthma: does it matter?

Objective Various intravenous (IV) corticosteroids are available for acute severe asthma (ASA) treatment. The choice of IV corticosteroids varies broadly and depends on institution, country, or physician preferences. In this study, we compared the efficacy of IV methylprednisolone, hydrocortisone and dexamethasone in ASA treatment during pediatric intensive care unit (PICU) admission. Methods The study was a prospective randomized clinical trial. We enrolled patients of 1–21 years after they were admitted to the PICU requiring continuous beta-2 agonist treatment. Patients were randomized into three groups: Group A: IV Methylprednisolone, Group B: IV Hydrocortisone and Group C: IV Dexamethasone. The primary outcomes measured were durations of beta-2 agonist continuous nebulization treatment. Secondary outcomes, included PICU and hospital length of stay (LOS), pediatric asthma severity score (PASS), need for mechanical ventilation and maximum dose of beta-2 agonist treatment. Results 61 patients were included in the analysis. 22 patients recruited in Group A, 20 in group B and 19 group C. Median durations of beta-2-agonist treatment were 23 h (QR 16–38) for methylprednisolone, 27 h (QR 16–40) for hydrocortisone, and 32 h (QR 16–48) for dexamethasone (p = 0.90). There was no difference in PICU LOS, hospital LOS, PASS score, B2 agonist maximum dose, or need for ventilation support. Conclusions The use of IV methylprednisolone, hydrocortisone, and dexamethasone have equivalent efficacy when used at the appropriate doses. Studies with larger cohorts are needed to compare the effectiveness of IV corticosteroids in the management of ASA in the PICU setting.

High-flow nasal cannula and bilevel positive airway pressure for pediatric status asthmaticus: a single center, retrospective descriptive and comparative cohort study

Introduction We aimed to describe patient characteristics and clinical outcomes for children hospitalized for status asthmaticus (SA) receiving high-flow nasal cannula (HFNC) or bilevel positive airway pressure (BiPAP). Methods We performed a single center, retrospective cohort study among 39 children admitted for SA aged 5–17 years from January 2016 to May 2019 to a quaternary pediatric intensive care unit (PICU). Cohorts were defined by BiPAP versus HFNC exposure and assessed to determine if differences existed in demographics, anthropometrics, comorbidities, asthma severity indices, historical factors, duration of noninvasive ventilation, and asthma-related clinical outcomes (i.e. length of stay, mechanical ventilation rates, exposure to concurrent sedatives/anxiolysis, and rate of adjunctive therapy exposure). Results Thirty-three percent (n = 13) received HFNC (33%) and 67% (n = 26) BiPAP. Children receiving BiPAP had greater age (10.9 ± 3.7 vs. 6.8 ± 2.2 years, P < 0.01), asthma severity (proportion with severe NHLBI classification: 38% vs. 0%, P < 0.01; median pediatric asthma severity score: 13[12,14] vs. 10[9,12], P < 0.01), previous PICU admissions (62% vs. 15%, P = 0.01), frequency of prescribed anxiolysis/sedation (42% vs. 8%, P = 0.02), and median duration of continuous albuterol (1.7[1,3.1] vs. 0.9[0.7,1.6] days, P = 0.03) compared to those on HFNC. Those on HFNC more commonly were treated comorbid bacterial pneumonia (69% vs. 19%, P < 0.01). No differences in NIV duration, mortality, mechanical ventilation rates, or LOS were observed. Conclusions Our data suggest a trial of BiPAP or HFNC appears well tolerated in children with SA. Prospective trials are needed to establish modality superiority and identify patient or clinical characteristics that prompt use of HFNC over BiPAP.

Pediatric acute asthma scoring systems: a systematic review and survey of UK practice.

BackgroundAcute exacerbations of asthma are common in children. Multiple asthma severity scores exist, but current emergency department (ED) use of severity scores is not known.MethodsA systematic review was undertaken to identify the parameters collected in pediatric asthma severity scores. A survey of Paediatric Emergency Research in the United Kingdom and Ireland (PERUKI) sites was undertaken to ascertain routinely collected asthma data and information about severity scores. Included studies examined severity of asthma exacerbation in children 5–18 years of age with extractable severity parameters.ResultsSixteen articles were eligible, containing 17 asthma severity scores. The severity scores assessed combinations of 15 different parameters (median, 6; range, 2–8). The most common parameters considered were expiratory wheeze (15/17), inspiratory wheeze (13/17), respiratory rate (10/17), and general accessory muscle use (9/17). Fifty‐nine PERUKI centers responded to the questionnaire. Twenty centers (33.1%) currently assess severity, but few use a published score. The most commonly recorded routine data required for severity scores were oxygen saturations (59/59, 100%), heart rate, and respiratory rate (58/59, 98.3% for both). Among well‐validated scores like the Pulmonary Index Score (PIS), Pediatric Asthma Severity Score (PASS), Childhood Asthma Score (CAS), and the Pediatric Respiratory Assessment Measure (PRAM), only 6/59 (10.2%), 3/59 (5.1%), 1/59 (1.7%), and 0 (0%) of units respectively routinely collect the data required to calculate them.ConclusionStandardized published pediatric asthma severity scores are infrequently used. Improved routine data collection focusing on the key parameters common to multiple scores could improve this, facilitating research and audit of pediatric acute asthma.

Association of serum 25-OH vitamin D₃ with serum IgE and the Pediatric Asthma Severity Score in patients with pediatric asthma.

Background: Pediatric asthma is a prevalent disease and has a significant immunologic and inflammatory nature. In recent years, the role of vitamin D₃ in immunologic processes has been studied, and many aspects of this role have been clarified in some human diseases. Objective: The aim of this study was to evaluate the relationship among the vitamin D₃ status, Pediatric Asthma Severity Score (PASS), and inflammatory indicators of pediatric asthma. Methods: Among all of the pediatric patients with asthma and with asthma exacerbation, 100 patients were randomly enrolled in the study and subdivided into three groups according to serum levels of 25-OH vitamin D₃. The control group consisted of 100 sex- and age-matched healthy subjects. Asthma exacerbation severity was evaluated based on the PASS before starting the medical care. The count of the white blood cells, eosinophil count, and serum levels of total immunoglobulin E (IgE) plus 25-OH vitamin D₃ were measured in all the subjects. The obtained data were then compared via proper statistical tests. A p value of <0.05 was considered as statistically significant. Results: The median level of serum IgE was increased in patients with vitamin D₃ deficiency compared with other groups. There was a significant inverse correlation between serum levels of 25-OH vitamin D₃ and IgE in pediatric patients with asthma (r = -0.483, p = 0.001). Furthermore, the serum levels of 25-OH vitamin D₃ also significantly inversely correlated with the PASS (r = -0.285, p = 0.004). Conclusion: Vitamin D₃ deficiency is associated with exacerbation severity and serum IgE levels in patients with pediatric asthma; hence, it can have an important role in pediatric asthma pathogenesis, possibly through IgE.

Pediatric asthma severity scores distinguish suitable inpatient level of care for children admitted for status asthmaticus

Objective: To determine if the Pediatric Asthma Severity Score (PASS) can distinguish “late-rescues” (transfer to the pediatric intensive care unit [PICU] within 24-hours of general pediatric floor admission), “PICU readmissions” (readmission within 24-h after transfer to a lower inpatient level of care), and unplanned 30-day hospital readmission in children admitted with status asthmaticus.Methods: We performed a single center, retrospective cohort study in 328 children admitted for asthma exacerbation aged 5–18 years from May 2015 to October 2017. We sought to determine if PASS values preceding admission from the emergency department or transfer to the general pediatric unit will be greater in children with late rescues and PICU readmissions and if a cutoff PASS values exist to discriminate these events prior to intrafacility transfer.Results: Nine (5%) late-rescues and 5 (3%) PICU readmissions accounted for 14/328 (4%) composite outcomes. PASS values were greater in children with these events (8 [IQR:5–8] vs. 5 [IQR:3–6], p < .01). Logistic regression of PASS on composite outcome yielded an odds ratio of 1.4 (1.1–1.8, p < .01) and ROC curve of PASS on a composite outcome yielded an AUC of 0.74 (0.61–0.87) with a threshold of ≥ 9. Nine (3%) children experienced unplanned 30-day hospital readmissions but PASS preceding hospital discharge was neither discriminative nor associated with hospital readmission.Conclusions: PASS values ≥ 9 identify children at increased risk for late-rescue and PICU readmission. Applied with traditionally criteria for selection of inpatient level of care, PASS may assist providers in reducing acute inpatient disposition errors.

Implementing a Respiratory Therapist-Driven Continuous Albuterol Weaning Protocol in the Pediatric ICU.

Status asthmaticus is one of the most frequent admission diagnoses in the pediatric ICU (PICU). Collaboration between respiratory therapists (RTs) and physicians may help efficiently deliver care to a patient in status asthmaticus. The Pediatric Asthma Severity Score (PASS) is a measure of severity of a patient's asthma exacerbation at a point in time. The aim of this quality improvement initiative was to establish an RT-driven continuous albuterol weaning protocol using the PASS score. We hypothesized that this would decrease the duration of continuous albuterol without increasing adverse events. This was a single-center implementation study in the PICU of a quaternary care children's hospital. Patients with a diagnosis of status asthmaticus who met criteria on continuous albuterol between September 2015 and September 2017 were included. An interdisciplinary team established the protocol, order sets, documentation, and education for involved staff. Qualifying subjects were assessed by an RT per protocol and assigned a PASS score, and the albuterol dose was adjusted on the basis of the PASS score. We compared 104 subjects studied before the implementation of this protocol (September 2015 to August 2016) to 117 subjects after the implementation of this protocol (September 2016 to October 2017). Median (interquartile range) duration of continuous albuterol in the PICU post-implementation was unchanged compared to pre-implementation: 12.1 (7.2-21.0) h versus 11.1 (6-19) h (P = .22). Median PICU length of stay was also unchanged post-implementation compared to pre-implementation: 19.5 (14.3-29.7) h versus 23.2 (15.2-31.3) h (P = .16). Using control charts, these processes were stable. There was no difference in adverse events. An interprofessionally-developed, RT-driven continuous albuterol weaning protocol can be implemented without negatively impacting duration of continuous albuterol or PICU length of stay and without increasing adverse events.

Implementation of a Modified Pediatric Asthma Severity Score (MPASS) to Reduce Length of Stay for Pediatric Asthma Patients: A Quality Improvement Study

Implementation of a Modified Pediatric Asthma Severity Score (MPASS) to Reduce Length of Stay for Pediatric Asthma Patients: A Quality Improvement Study

The Effect of a Pediatric Intensive Care Severity-Tiered Pathway for Status Asthmaticus on Quality Measures and Outcomes.

Background: Patients with status asthmaticus admitted to the hospital contribute tremendous costs to the healthcare system. Treatment protocols directed at improving care to pediatric inpatients have improved both clinical and financial outcomes; however, there are limited data demonstrating the impact of goal-driven therapy for patients with status asthmaticus in the pediatric intensive care unit (PICU). The purpose of this initiative was to standardize care of children with status asthmaticus in the PICU to improve clinical outcomes. Materials and Methods: A goal-directed clinical pathway using a validated pediatric asthma severity score was developed. A pre-post intervention assessed patients 2-17 years of age admitted to the PICU with status asthmaticus. The effect of the protocol was measured from October 2015 to October 2016. The primary outcome was the transition time interval from continuous nebulized bronchodilator therapy to every 2 hourly intermittent treatments. Secondary outcomes related to treatment options and clinical complications were also assessed. Results: Postintervention patient (n = 124) demographics were similar to those in the preintervention group (n = 130). Compared with baseline, there was a 4.9-h decrease in the mean transition time from continuous to intermittent bronchodilator use (31.9 versus 27.0, P = 0.033) following the intervention. The mean and median hospital length of stay (LOS) was significantly decreased in the postintervention group by 14.76 h (P = 0.011) and 16.68 h (P = 0.003). There were no readmissions to the PICU in the postintervention group. The use of rescue BiPAP (Bi-level positive airway pressure ventilation) was significantly higher in the preintervention group compared with the postintervention group (42% versus 28%, P = 0.036). Conclusions: A severity-tiered, goal-driven treatment pathway for pediatric patients admitted to the PICU with status asthmaticus reduced the time required to transition from continuous to intermittent inhaled bronchodilator use. As a result, overall hospital LOS was significantly decreased with no increase in clinical complications.

Paediatric ED BiPAP continuous quality improvement programme with patient analysis: 2005–2013

ObjectiveIn paediatric moderate-to-severe asthmatics, there is significant bronchospasm, airway obstruction, air trapping causing severe hyperinflation with more positive intraplural pressure preventing passive air movement. These effects cause an increased respiratory...

Pediatric asthma severity score is associated with critical care interventions.

AIMTo determine if a standardized asthma severity scoring system (PASS) was associated with the time spent on continuous albuterol and length of stay in the pediatric intensive care unit (PICU).METHODSThis is a single center, retrospective chart review study at a major children’s hospital in an urban location. To qualify for this study, participants must have been admitted to the PICU with a diagnosis of status asthmaticus. There were a total of 188 participants between the ages of two and nineteen, excluding patients receiving antibiotics for pneumonia. PASS was calculated upon PICU admission. Subjects were put into one of three categories based on PASS: ≤ 7 (mild), 8-11 (moderate), and ≥ 12 (severe). The groups were compared based on different variables, including length of continuous albuterol and PICU stay.RESULTSThe age distribution across all groups was similar. The median length of continuous albuterol was longest in the severe group with a duration of 21.5 h (11.5-27.5), compared to 15 (7.75-23.75) and 10 (5-15) in the moderate and mild groups, respectively (P = 0.001). The length of stay was longest in the severe group, with a stay of 35.6 h (22-49) compared to 26.5 (17-30) and 17.6 (12-29) in the moderate and mild groups, respectively (P = 0.001).CONCLUSIONA higher PASS is associated with a longer time on continuous albuterol, an increased likelihood to require noninvasive ventilation, and a longer stay in the ICU. This may help safely distribute asthmatics to lower and higher levels of care in the future.

The RAD score: a simple acute asthma severity score compares favorably to more complex scores

Acute asthma severity scores facilitate assessment and implementation of timely and appropriate therapy for pediatric patients but are complex and challenging for clinicians to use at the bedside. To assess whether a simple, bedside acute asthma severity score comprising 3 standard clinical measures performs as well as more comprehensive asthma scores. We prospectively enrolled participants 5 to 17 years of age with acute asthma exacerbations. We recorded 3 asthma scores at baseline and after 2 hours of treatment: the Pediatric Asthma Severity Score (PASS), the Pediatric Respiratory Assessment Measure (PRAM), and the RAD score (Respiratory rate; Accessory muscle use; Decreased breath sounds). We assessed each score for criterion validity in predicting baseline percent forced expiratory volume in 1 second (%FEV(1)) and for responsiveness in predicting change of %FEV(1) after 2 hours of treatment using multiple linear regression models adjusted for age, race, sex, and Global Initiative for Asthma chronic control. Of 536 participants included for analyses, median age was 8.8 years, 60% were male, and 58% were African American. The 3 acute asthma scores demonstrated similar criterion validity to explain variation of baseline %FEV(1) (R(2): 0.434 [PASS]; 0.462 [PRAM]; 0.426 [RAD]), but none demonstrated clinically significant responsiveness to change in %FEV(1) (R(2): 0.109 [PASS]; 0.106 [PRAM]; 0.139 [RAD]). The RAD score, comprising 3 routinely measured bedside clinical parameters, is a simple and easily used instrument for assessing the severity of an acute asthma exacerbation and has comparable criterion validity and improved responsiveness when compared with 2 more complex acute asthma scores.

Prospective Evaluation of Two Clinical Scores for Acute Asthma in Children 18 Months to 7 Years of Age

The objective was to evaluate the discriminatory ability of two clinical asthma scores, the Preschool Respiratory Assessment Measure (PRAM) and the Pediatric Asthma Severity Score (PASS), during an asthma exacerbation. This was a prospective cohort study in an academic pediatric emergency department (ED; 60,000 visits/year) conducted from March 2006 to October 2007. All patients 18 months to 7 years of age who presented for an asthma exacerbation were eligible. The primary outcome was a length of stay (LOS) of >6 hours in the ED or admission to the hospital. Clinical findings and components of the PRAM and the PASS were assessed by a respiratory therapist (RT) at the start of the ED visit and after 90 minutes of treatment. During the study period, 3,845 patients were seen in the ED for an asthma exacerbation. Of these, 291 were approached to participate, and eight refused. Moderate levels of discrimination were found between a LOS of >6 hours and/or admission and PRAM (area under the receiver-operating characteristic curve [AUC] = 0.69, 95% confidence interval [CI] = 0.59 to 0.79) and PASS (AUC = 0.70, 95% CI = 0.60 to 0.80) as calculated at the start of the ED visit. Significant similar correlations were seen between the physician's judgment of severity and PRAM (r = 0.54, 95% CI = 0.42 to 0.65) and PASS (r = 0.55, 95% CI = 0.43 to 0.65). The PRAM and PASS clinical asthma scores appear to be measures of asthma severity in children with discriminative properties.

Pediatric Clinical Asthma Scores Predict Disease Severity

Investigators prospectively assessed the usefulness of two pediatric asthma assessment tools — the Preschool Respiratory Assessment Measure (PRAM) and the Pediatric Asthma Severity Score (PASS) — for predicting prolonged (≥6 hours) emergency department (ED) stay and hospital admission in a convenience sample of patients aged 18 months to 7 years …

411: Correlation of Pediatric Asthma Severity Score and End Tidal CO 2 Values With Asthma Severity in the Pediatric Population

411: Correlation of Pediatric Asthma Severity Score and End Tidal CO 2 Values With Asthma Severity in the Pediatric Population

Predicting Need for Hospitalization in Acute Pediatric Asthma

To develop and validate predictive models to determine the need for hospitalization in children treated for acute asthma in the emergency department (ED). Prospective cohort study of children aged 2 years and older treated at 2 pediatric EDs for acute asthma. The primary outcome was successful ED discharge, defined as actual discharge from the ED and no readmission for asthma within 7 days, versus need for extended care. Among those defined as requiring extended care, a secondary outcome of inpatient care (>24 hours) or short-stay care (<24 hours) was defined. Logistic regression and recursive partitioning were used to create predictive models based on historical and clinical data from the ED visit. Models were developed with data from 1 ED and validated in the other. There were 852 subjects in the derivation group and 369 in the validation group. A model including clinical score (Pediatric Asthma Severity Score) and number of albuterol treatments in the ED distinguished successful discharge from need for extended care with an area under the receiver-operator characteristic curve of 0.89 (95% confidence interval [CI], 0.87-0.92) in the derivation group and 0.92 (95% CI, 0.89-0.95) in the validation group. Using a score of 5 or more as a cutoff, the likelihood ratio positive was 5.2 (95% CI, 4.2-6.5), and the likelihood ratio negative was 0.22 (95% CI, 0.17-0.28). Among those predicted to need extended care, a classification tree using number of treatments in the ED, clinical score at end of ED treatment, and initial pulse oximetry correctly classified 63% (95% CI, 56-70) of the derivation group as short stay or inpatient, and 62% (95% CI, 55-68) of the validation group. Successful discharge from the ED for children with acute asthma can be predicted accurately using a simple clinical model, potentially improving disposition decisions. However, predicting correct placement of patients requiring extended care is problematic.

End‐tidal Carbon Dioxide Measurements in Children with Acute Asthma

A noninvasive method to assess ventilation may aid in management of children with acute asthma. The purpose of this study was to evaluate the association between end-tidal carbon dioxide (EtCO2) values and disease severity among children with acute asthma. This was a prospective, blinded, observational study of children 3-17 years old treated for acute asthma in a pediatric emergency department (ED). EtCO2 measurements were taken before the initiation of therapy and after each nebulization treatment (maximum of three). Peak expiratory flow rate (PEFR), Pediatric Asthma Severity Score (PASS), oxygen saturation, and disposition were recorded. Treating physicians, unaware of the EtCO2 results, made all treatment decisions, including disposition. One hundred children were enrolled. The mean initial EtCO2 value was 35 mm Hg (95% confidence interval = 34.3 to 36.1 mm Hg). The mean disposition EtCO2 value was 33.3 mm Hg (95% confidence interval = 32.6 to 34.4 mm Hg). PEFR measures were completed on 43 patients and PASS recorded on 100 patients. There was an overall trend toward lower EtCO2 values during treatment (p < 0.01). Sixteen patients were admitted. Initial EtCO2 values were lower among children admitted to the hospital (35.6 mm Hg vs. 32.9 mm Hg; Mann-Whitney U test; p < 0.02). EtCO2 values at disposition did not differ between groups based on PEFR, PASS, or hospital admission. Noninvasive bedside measurement of EtCO2 values among children with acute asthma is feasible. EtCO2 values did not distinguish children with mild disease from those with more severe disease. Further data are needed to clarify the association between EtCO2 values and other indicators of disease severity, particularly in children with more severe disease.

End-tidal Carbon Dioxide Measurements in Children with Acute Asthma

Objectives A noninvasive method to assess ventilation may aid in management of children with acute asthma. The purpose of this study was to evaluate the association between end-tidal carbon dioxide (EtCO2) values and disease severity among children with acute asthma. Methods This was a prospective, blinded, observational study of children 3–17 years old treated for acute asthma in a pediatric emergency department (ED). EtCO2 measurements were taken before the initiation of therapy and after each nebulization treatment (maximum of three). Peak expiratory flow rate (PEFR), Pediatric Asthma Severity Score (PASS), oxygen saturation, and disposition were recorded. Treating physicians, unaware of the EtCO2 results, made all treatment decisions, including disposition. Results One hundred children were enrolled. The mean initial EtCO2 value was 35 mm Hg (95% confidence interval = 34.3 to 36.1 mm Hg). The mean disposition EtCO2 value was 33.3 mm Hg (95% confidence interval = 32.6 to 34.4 mm Hg). PEFR measures were completed on 43 patients and PASS recorded on 100 patients. There was an overall trend toward lower EtCO2 values during treatment (p < 0.01). Sixteen patients were admitted. Initial EtCO2 values were lower among children admitted to the hospital (35.6 mm Hg vs. 32.9 mm Hg; Mann-Whitney U test; p < 0.02). EtCO2 values at disposition did not differ between groups based on PEFR, PASS, or hospital admission. Conclusions Noninvasive bedside measurement of EtCO2 values among children with acute asthma is feasible. EtCO2 values did not distinguish children with mild disease from those with more severe disease. Further data are needed to clarify the association between EtCO2 values and other indicators of disease severity, particularly in children with more severe disease.