{
  "abstract": "Background The ability of paediatric asthma scores to predict admission following initial bronchodilator therapy has not been comprehensively evaluated.Methods A multicentre observational study including children aged 2–18 years who received at least a single dose of bronchodilator following presentation to four Australian emergency departments (EDs). Observations were obtained by trained research nurses before and after initial treatment to calculate ten common asthma scores (Pediatric Respiratory Assessment Measure (PRAM), Siriraj Clinical Asthma Score (SiCAS), Clinical Asthma Score (CAS), Acute Asthma Intensity Research Score (AAIRS), Modified Pulmonary Index Score (MPIS), Pulmonary Index Score (PIS), Pediatric Asthma Score (PAS), Pediatric Asthma Severity Score (PASS), Woods and Downs and Pulmonary Score (WDCAS)). Primary outcome was determining the global ability of scores to discriminate between those admitted and discharged, assessed by an area under receiver operating curve (AUC ROC) ≥0.80. Secondary outcomes included adjusted ORs and the ability to provide an adequate balance between sensitivity and specificity (defined as Youden Index ≥50%).Results Of the 1238 patients enrolled, 792 (64.0%) were male, median age was 3 years (IQR 2–6), and 513 (41.4%) met the admission criteria. None of the asthma scores demonstrated an AUC ROC ≥0.80, with the four best performing (MPIS, SCAS, PIS and PAS) scoring between 0. 70 and 0.73. Results for adjusted OR analysis indicated that each one-point increase was associated with increased odds of admission for all 10 asthma scores (p=<0.001). No asthma score achieved a Youden Index ≥50%.Conclusion None of the asthma scores assessed in this study met the predetermined primary outcome of an AUC ROC ≥0.80.",
  "authors": [
    {
      "affiliations": [
        "Emergency Department, Flinders Medical Centre, Bedford Park, South Australia, Australia",
        "College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia"
      ],
      "name": "Charmaine Gray"
    },
    {
      "affiliations": [
        "Emergency Department, Flinders Medical Centre, Bedford Park, South Australia, Australia",
        "College of Medicine and Public Health, Flinders University, Adelaide, South Australia, Australia"
      ],
      "name": "Leah Armit"
    },
    {
      "affiliations": [
        "Emergency Department, Royal Childrens Hospital, Parkville, Victoria, Australia",
        "Murdoch Children's Research Institute, Melbourne, Victoria, Australia",
        "Department of Paediatrics, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia"
      ],
      "name": "Franz E Babl"
    },
    {
      "affiliations": [
        "Department of Surgery and Paediatrics Child and Youth Health, The University of Auckland, Auckland, New Zealand",
        "Children’s Emergency Department, Starship Children’s Health, Auckland, New Zealand"
      ],
      "name": "Stuart Dalziel"
    },
    {
      "affiliations": [
        "Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia",
        "Emergency Department, Perth Children's Hospital, Nedlands, Perth, Western Australia"
      ],
      "name": "Meredith Louise Borland"
    },
    {
      "affiliations": [
        "Divisions of Paediatrics and Emergency Medicine, University of Western Australia, Crawley, Western Australia, Australia",
        "Emergency Department, Perth Children's Hospital, Nedlands, Perth, Western Australia"
      ],
      "name": "Sharon O’Brien"
    },
    {
      "affiliations": [
        "Emergency Department, Royal Childrens Hospital, Parkville, Victoria, Australia"
      ],
      "name": "Doris Tham"
    },
    {
      "affiliations": [
        "Biostatistics Unit, Monash University, Melbourne, Victoria, Australia",
        "Department of Psychiatry, Monash University, Melbourne, Victoria, Australia"
      ],
      "name": "Mohammad Asghari-Jafarabadi"
    },
    {
      "affiliations": [
        "Murdoch Children's Research Institute, Melbourne, Victoria, Australia",
        "Department of Paediatrics, Monash University, Melbourne, Victoria, Australia",
        "Paediatric Emergency Department, Monash Health, Clayton, Victoria, Australia"
      ],
      "name": "Simon Craig"
    },
    {
      "affiliations": [],
      "name": "On behalf of the Paediatric Research in Emergency Departments International Collaborative (PREDICT)"
    }
  ],
  "title": "Diagnostic accuracy study assessing the ability of paediatric asthma scores to predict admission following initial emergency department bronchodilator therapy: a Clinical Asthma Scoring systems in Paediatric Emergency (CASPER) study",
  "uid": "f5a4a03c-1aef-5b8b-bb17-1740fa55068c"
}