A Clinical Asthma Score (CAS) Predicts need For Admission of Asthmatic patients from a Pediatric Emergency Department.

Background: Asthma is the leading diagnosis for visits to the Children’s hospital Oakland Emergency Department (ED), accounting for 13% of all ED visits. We developed a tool, the Clinical Asthma Score (CAS); a modification of the Woods Downes asthma score, to objectively evaluate our asthmatic patients’ degree of respiratory distress. This scores evaluates three aspects of a patient’s respiratory distress. This scores evaluates three aspects of patient's degree of respiratory distress. This scores evaluates three aspects of a patient's respiratory distress: (1) degree of wheezing, (2) degree of retraction and/or flaring, and (3) degree of dyspnea. Each category is given a score of )-3, so the total score ranges from 0-9, with 9 being the worst score.

The CAS has allowed the Ed caregivers a simple system for identifying degree of respiratory dysfunction and for standardizing treatment. The purpose of this study was to evaluate the usefulness of the CAS in predicting need for admission to the hospital from the ED.

Methods: Between Sept. 1, 2001 and Feb. 3, 2002 we used the CAS to evaluate asthma severity in patients seen in our ED, and correlate it with admission status. Patients were first scored by a nurse in the Triage Room, then were examined by the ED physician. The ED physicians were unaware of the CAS, and subsequent decisions to admit the patient to the hospital were made independently of the CAS.

We analyzed the admission rates of all asthmatic patients seen in the ED during the study period for whom a CAS was assigned in the Triage Room. The rates of admission were calculated for each score, so that we could identify predictive “break points” in the scores.

Results: During the study period, 306 patients between the ages of 2 and 17 were seen in triage for asthma. Of these, 47 (26%) had scores of 0-2, 182 (59%) had scores of 3-6, and 77 (25%) had scores of 7-9. As shown in the Table, scores of 0-2 predicted a low risk of subsequent admission, while scores of 7-9 predicted a high risk for subsequent admission.

Conclusions: The CAS is a relatively reliable predictor of risk of admission from the ED for pediatric patients with asthma, if their scores are at the low (0-2) or high (7-9) end of the spectrum. For those patients with middle scores (3-6), the risk of admission is approximately 50%. We conclude that the CAS is a useful tool for predicting need for admission at the time of triage. We speculate that the addition of other parameters, such as pulse oximetry and peak expiratory flow,will further improve its predictive value.