Score | |||||
---|---|---|---|---|---|
0 | 1 | 2 | 3 | ||
Oxygen saturation, % | >95 | 93–95 | 90–92 | <90 | |
Accessory muscle use | None | Mild | Moderate | Severe | |
Inspiratory-to-expiratory flow ratio | 2:1 | 1:1 | 1:2 | 1:3 | |
Wheezing | None | End expiratory |
Inspiratory and expiratory wheeze, good aeration |
Inspiratory and expiratory wheeze, decreased aeration |
|
Heart rate, (/min) | |||||
<3 years old | <120 | 120–140 | 141–160 | >160 | |
≥3 years old | <100 | 100–120 | 121–140 | >140 | |
Respiratory rate, (/min) | |||||
<6 years old | ≤30 | 31–45 | 46–60 | >60 | |
≥6 years old | ≤20 | 21–35 | 36–50 | >50 |
All ages (N = 2,242) |
1–5 years (N = 1,597) |
6–18 years (N = 645) |
||
---|---|---|---|---|
Age (median [IQR]) | 3 (2–6) | 2 (1–3) | 8 (7–10) | |
Gender (M:F) | 53:47 | 51:49 | 58:42 | |
Body temperature ≥ 38.0°C at initial assessment (N [%]) |
416 (18.6) | 341 (21.4) | 75 (11.6) | |
MPIS at initial assessment (mean [SD]) |
7.1 (3.6) | 7.3 (3.5) | 6.5 (3.7) | |
Severity of asthma (JPGL) (N [%]) | ||||
Mild | 862 (38.4) | 591 (37.0) | 271 (42.0) | |
Moderate | 1,129 (50.4) | 834 (52.2) | 295 (45.7) | |
Severe | 242 (10.8) | 164 (10.2) | 78 (12.1) | |
Respiratory failure | 9 (0.4) | 8 (0.5) | 1 (0.2) | |
Disposition (N [%]) | ||||
Non-admission | 1,576 (70.3) | 1,103 (69.1) | 473 (73.3) | |
Hospital admission | 666 (29.7) | 494 (30.9) | 172 (26.7) | |
PICU admission | 8 (1.2) | 5 (1.0) | 3 (1.7) | |
Outcomes after hospital admission | ||||
Continuous inhalation required (N [%]) |
29 (4.3) | 17 (3.4) | 12 (7.0) | |
Ventilator support required (N [%]) |
8 (1.2) | 5 (1.0) | 3 (1.7) | |
Length of oxygen inhalation in days (median [IQR]) |
3 (2–5) | 3 (2–4) | 3 (2–5) | |
Length of hospital stay in days (median [IQR]) |
5 (4–9) | 5 (4–9) | 6 (4–11) |
Odds Ratio | 95% Confidential Interval |
p | ||
---|---|---|---|---|
Age class: 1–5 years | 1.00 | 0.78–1.30 | 0.981 | |
Body temperature: ≥38.0 | 1.59 | 1.21–2.08 | <0.001 | |
MPIS items: Score ≥2 | ||||
Oxygen saturation | 4.20 | 3.07–5.75 | <0.001 | |
Accessory muscle use | 2.05 | 1.60–2.63 | <0.001 | |
Inspiratory-to-expiratory flow ratio | 1.59 | 1.25–2.03 | <0.001 | |
Wheezing | 2.23 | 1.75-2.83 | <0.001 | |
Heart rate | 1.95 | 1.51–2.51 | <0.001 | |
Respiratory rate | 2.41 | 1.91–3.05 | <0.001 |
Age | BT | MPIS | Sens | Spec | LR+ | LR− | PPV | NPV | Sens + Spec |
AUC | |
---|---|---|---|---|---|---|---|---|---|---|---|
All ages | |||||||||||
All | ≥12 | 0.291 | 0.968 | 9.182 | 0.732 | 0.795 | 0.764 | 1.260 | 0.825 | ||
≥11 | 0.428 | 0.924 | 5.667 | 0.619 | 0.705 | 0.793 | 1.352 | (0.807–0.844) | |||
≥10 | 0.578 | 0.854 | 3.961 | 0.494 | 0.626 | 0.827 | 1.432 | ||||
≥9 | 0.728 | 0.776 | 3.251 | 0.350 | 0.579 | 0.871 | 1.504 | ||||
≥8 | 0.836 | 0.674 | 2.564 | 0.243 | 0.520 | 0.907 | 1.510 | * | |||
≥7 | 0.899 | 0.576 | 2.122 | 0.175 | 0.473 | 0.931 | 1.476 | ||||
≥38 | ≥12 | 0.350 | 0.953 | 7.408 | 0.682 | 0.853 | 0.651 | 1.303 | 0.830 | ||
≥11 | 0.530 | 0.906 | 5.614 | 0.519 | 0.815 | 0.710 | 1.436 | (0.791–0.869) | |||
≥10 | 0.672 | 0.845 | 4.350 | 0.388 | 0.774 | 0.767 | 1.518 | * | |||
≥9 | 0.781 | 0.708 | 2.678 | 0.309 | 0.678 | 0.805 | 1.490 | ||||
≥8 | 0.885 | 0.549 | 1.964 | 0.209 | 0.607 | 0.859 | 1.435 | ||||
≥7 | 0.951 | 0.412 | 1.617 | 0.119 | 0.559 | 0.914 | 1.363 | ||||
<38 | ≥12 | 0.269 | 0.971 | 9.268 | 0.753 | 0.769 | 0.787 | 1.240 | 0.817 | ||
≥11 | 0.389 | 0.928 | 5.389 | 0.658 | 0.660 | 0.809 | 1.317 | (0.796–0.840) | |||
≥10 | 0.542 | 0.856 | 3.755 | 0.535 | 0.575 | 0.839 | 1.398 | ||||
≥9 | 0.708 | 0.788 | 3.337 | 0.371 | 0.545 | 0.882 | 1.496 | ||||
≥8 | 0.818 | 0.695 | 2.685 | 0.262 | 0.491 | 0.914 | 1.513 | * | |||
≥7 | 0.880 | 0.605 | 2.225 | 0.199 | 0.445 | 0.933 | 1.485 | ||||
1–5 years | |||||||||||
All | ≥12 | 0.279 | 0.967 | 8.559 | 0.745 | 0.793 | 0.750 | 1.247 | 0.820 | ||
≥11 | 0.427 | 0.924 | 5.609 | 0.620 | 0.715 | 0.783 | 1.351 | (0.799–0.842) | |||
≥10 | 0.595 | 0.843 | 3.794 | 0.480 | 0.630 | 0.823 | 1.438 | ||||
≥9 | 0.737 | 0.755 | 3.010 | 0.348 | 0.574 | 0.865 | 1.492 | * | |||
≥8 | 0.844 | 0.643 | 2.363 | 0.242 | 0.514 | 0.902 | 1.487 | ||||
≥7 | 0.903 | 0.542 | 1.972 | 0.179 | 0.469 | 0.926 | 1.445 | ||||
≥38 | ≥12 | 0.342 | 0.947 | 6.466 | 0.695 | 0.839 | 0.642 | 1.289 | 0.812 | ||
≥11 | 0.533 | 0.894 | 5.036 | 0.522 | 0.802 | 0.704 | 1.427 | (0.768–0.857) | |||
≥10 | 0.664 | 0.825 | 3.806 | 0.407 | 0.754 | 0.754 | 1.490 | * | |||
≥9 | 0.770 | 0.672 | 2.346 | 0.343 | 0.654 | 0.784 | 1.442 | ||||
≥8 | 0.882 | 0.508 | 1.792 | 0.233 | 0.590 | 0.842 | 1.390 | ||||
≥7 | 0.954 | 0.376 | 1.528 | 0.123 | 0.551 | 0.910 | 1.330 | ||||
<38 | ≥12 | 0.251 | 0.972 | 8.840 | 0.770 | 0.768 | 0.776 | 1.223 | 0.814 | ||
≥11 | 0.380 | 0.930 | 5.429 | 0.667 | 0.670 | 0.800 | 1.310 | (0.789–0.840) | |||
≥10 | 0.564 | 0.847 | 3.684 | 0.514 | 0.580 | 0.839 | 1.411 | ||||
≥9 | 0.722 | 0.772 | 3.174 | 0.360 | 0.543 | 0.881 | 1.495 | ||||
≥8 | 0.827 | 0.671 | 2.513 | 0.257 | 0.485 | 0.912 | 1.498 | * | |||
≥7 | 0.880 | 0.577 | 2.079 | 0.208 | 0.438 | 0.928 | 1.457 | ||||
6–18 years | |||||||||||
All | ≥12 | 0.326 | 0.970 | 11.000 | 0.695 | 0.800 | 0.798 | 1.296 | 0.834 | ||
≥11 | 0.430 | 0.926 | 5.814 | 0.615 | 0.679 | 0.817 | 1.356 | (0.798–0.870) | |||
≥10 | 0.529 | 0.879 | 4.390 | 0.535 | 0.615 | 0.837 | 1.409 | ||||
≥9 | 0.703 | 0.825 | 4.009 | 0.360 | 0.593 | 0.884 | 1.528 | ||||
≥8 | 0.814 | 0.746 | 3.208 | 0.249 | 0.538 | 0.917 | 1.560 | * | |||
≥7 | 0.890 | 0.655 | 2.581 | 0.169 | 0.484 | 0.942 | 1.545 | ||||
≥38 | ≥12 | 0.387 | 0.977 | 17.032 | 0.627 | 0.923 | 0.694 | 1.364 | 0.895 | ||
≥11 | 0.516 | 0.955 | 11.355 | 0.507 | 0.889 | 0.737 | 1.471 | (0.814–0.976) | |||
≥10 | 0.710 | 0.932 | 10.409 | 0.312 | 0.880 | 0.820 | 1.641 | ||||
≥9 | 0.839 | 0.864 | 6.151 | 0.187 | 0.813 | 0.884 | 1.702 | * | |||
≥8 | 0.903 | 0.727 | 3.312 | 0.133 | 0.700 | 0.914 | 1.630 | ||||
≥7 | 0.935 | 0.568 | 2.166 | 0.114 | 0.604 | 0.926 | 1.504 | ||||
<38 | ≥12 | 0.312 | 0.970 | 10.298 | 0.709 | 0.772 | 0.811 | 1.282 | 0.823 | ||
≥11 | 0.411 | 0.923 | 5.348 | 0.638 | 0.637 | 0.827 | 1.334 | (0.783–0.863) | |||
≥10 | 0.489 | 0.874 | 3.888 | 0.584 | 0.561 | 0.839 | 1.363 | ||||
≥9 | 0.674 | 0.821 | 3.754 | 0.398 | 0.552 | 0.884 | 1.494 | ||||
≥8 | 0.794 | 0.748 | 3.155 | 0.275 | 0.509 | 0.917 | 1.543 | ||||
≥7 | 0.879 | 0.664 | 2.620 | 0.181 | 0.463 | 0.944 | 1.544 | * |
GINA | BTS/SIGN | EPR3 | JPGL | |||
---|---|---|---|---|---|---|
1–5 years | >5 years | 1–5 years | >5 years | |||
SpO2 (%) | ||||||
Mild | >95 | >95 | >95 | |||
Moderate | 92–95 | ≥92 | 90–95 | 92–95 | ||
Severe | <92 | <92 | <90 | <92 | ||
Life threatening | <90 | |||||
Heart rate (/minute) | ||||||
Mild | ≤200 (0–3 years) ≤180 (4–5 years) |
100–120 | <100 | |||
Moderate | ≤140 | ≤125 | 100–120 | |||
Severe | >200 (0–3 years) >180 (4–5 years) |
>120 | >140 | >125 | >120 | |
Life threatening | Bradycardia | |||||
Respiratory rate (/minute) | ||||||
Mild | Increased | Increased | Slightly increased | |||
Moderate | ≤40 | ≤30 | Increased | Increased | ||
Severe | >30 | >40 | >30 | Frequently >30 | Increased | |
Life threatening | Undetermined | |||||
Retraction, accessory muscle use | ||||||
Mild | Not used | Not usually | None-mild | |||
Moderate | Commonly | Apparent | ||||
Severe | Marked | In use | Poor respiratory effort | Usually | Marked | |
Life threatening | Paradoxical thoracoabdominal movement | Marked | ||||
Auscultation | ||||||
Mild | Variable | Moderate, often only end-expiratory wheeze |
Mild wheeze | |||
Moderate | Loud; throughout exhalation wheeze |
Apparent wheeze | ||||
Severe | may be quiet | Usually loud; throughout inhalation and exhalation wheeze | Marked wheeze | |||
Life threatening | Silent chest | Silent chest | Absence of wheeze | Reduced or eliminated | ||
Daily life | ||||||
Mild | Talks in sentences | Talks in sentences Breathless while walking Can lie down |
Talks in sentences, Normal feeding, Can sleep |
|||
Moderate | Talks in sentences | Talks in sentences | Talks in phrases Breathless while at rest Difficulty feeding Prefers sitting |
Talks in phrases, Difficulty feeding, Occasionally wakes up |
||
Severe | Talks in words or enable to drink | Cannot complete sentences in one breath or too breathless to talk or feed | Talks in words Breathless while at rest Stop feeding, sits upright |
Talks in words, Difficulty feeding, Disturbed sleep |
||
Life threatening | Unable to talk | Exhaustion | Impossible to talk Impossible to feed Disturbed sleep |
|||
Altered consciousness | ||||||
Mild | No altered consciousness | May be agitated | No altered consciousness | |||
Moderate | Agitated | Usually agitated | Slightly excited No altered consciousness |
|||
Severe | Agitated, confused, or drowsy |
Usually agitated | Excited Slightly lowered consciousness |
|||
Life threatening | Drowsy or confused | Confused | Drowsy or confused | Confused Lowered consciousness |
||
PEF (% predicted or % personal best) | ||||||
Mild | >50 | ≥70 | ≥60 | |||
Moderate | ≥50 | 40–69 | 30–60 | |||
Severe | ≤50 | 33–50 | <40 | <30 | ||
Life threatening | <33 | <25 | Unmeasurable |