The Science Journal of the American Association for Respiratory Care

2002 OPEN FORUM Abstracts

Use of a Clinical Asthma Score (CAS) as the Initial Step in an Asthma Treatment Algorithm in a Pediatric Emergency Department

Katie Sabato RRT, MS, Perry Picchi, RRT,Jeanette Asselin RRT, MS, Mary Rutherford MD, Children Hospital Oakland, OAkland California.

Background: Objective assessment of patients with asthma in the Emergency Department (ED) is difficult. To address this problem, we developed a Clinical Asthma Score (CAS, Table 1) a modification of the Woods Downes asthma score1 for assessing the severity of asthma in patients over the age of 2. We also developed an Asthma Treatment Algorithm that utilized the CAS as the first step in determining initial treatment. The algorithm stipulated that patients with CAS ³6 be immediately placed on a one hour 10 mg dose of continuous albuterol. We performed this study to (1) determine the concordance between initial evaluations with the CAS, and (2) to evaluate degree of compliance with the initial phase of the Asthma Treatment Algorithm

Methods: Between Sept. 1, 2001 and Feb. 3, 2002 we used the CAS to evaluate asthma severity in patients seen in our ED. Patients were first scored in the Triage Room, again in the ED, and finally examined by the ED physician. To evaluate agreement in CAS scoring between the Triage and ED evaluations, we collected data forms on patients seen in the ED during this 6 month period. To evaluate compliance with the Asthma Treatment Algorithm, we compared initial treatment with the CAS.

Results: During the study period, 268 patients were scored with the CAS in both Triage and in the ED Table 2 shows the concordance between the Triage and the ED scoring. Scores were identical in 78 929%) of the patients, within 1 point in 165 (62%), and within 2 points in 218 (81%). 135 (90%) of the 150 patients with a CAS ³6 received continuous albuterol as their first-line therapy.

Table 1

S Accessory Wheeze Dyspnea
0 No retractions No wheezing No dyspnea
1 Intercostal End Exp. Normal activity
2 Inter & Suprasternal Insp. & Exp. Activity 5-8 Words sentence
3 Nasal flaring Audible or silent Rather not speak severe

Table 2

Total patients 268
Identical Scores 78 (29%)
Scores within 1 point 165 (62%)
Scores within 2 points 218 (81%)

Conclusions: (1) The CAS is a simple and reliable score which is highly reproducible (81% scores within 2 points) for patients for who have serial evaluations. (2) Utilizing the CAS as the initial step in an asthma treatment algorithm leads to a high degree of success (90%) in immediately beginning continuous albuterol in patients with severe asthma.

1. Wood DW, Downes JJ, Lecks HI. A clinical scoring system for the diagnosis of respiratory failure. AM J Dis Child 1972; 123:227-228


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