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A Modified Pulmonary Index Score With Predictive Value for Pediatric Asthma Exacerbations

Connecticut Children’s Medical Center, Hartford, CT

PURPOSE: Several clinical asthma scores have been derived from combinations of physical findings in pediatric asthmatic patients. However, few scores have proven predictive value for asthma exacerbations. This study was designed to test the reproducibility and validity of one such score, the modified pulmonary index score (MPIS), and to assess its predictive value in children hospitalized for asthma.

METHODS: In the MPIS, six categories are evaluated: oxygen saturation, accessory muscle use, inspiratory to expiratory flow ratio, degree of wheezing, heart rate, and respiratory rate. For each of these six measurements or observations, a score of 0-3 is assigned. To assess the reproducibility of the MPIS, thirty inpatients with status asthmaticus (median age 6.4 years, range 0.8-17 years) were examined by an attending physician, nurse, and respiratory therapist who were blinded to the other observers’ scores. To assess the validity of the MPIS as a scale of severity of illness in asthmatic patients, the score at admission was compared with selected outcomes in the same thirty patients.

RESULTS: The MPIS is highly reproducible with a high degree of inter-rater reliability across caregiver groups (MD to RN: R=0.98, 95% CI>0.96; MD to RT: R=0.95, 95% CI>0.92; RN to RT: R=0.94, 95% CI>0.90). The admission MPIS positively correlated with ICU admission (p<0.01), days of continuous albuterol therapy (p<0.01), days of supplemental oxygen (p<0.01) and length of hospital stay (p<0.01).

CONCLUSIONS: The MPIS is highly reproducible and a valid indicator of severity of illness in children with asthma.

CLINICAL IMPLICATIONS: This is the first pediatric clinical asthma score demonstrated to be reproducible across three groups of health care professionals. The correlation between the MPIS and routinely measured clinical outcomes may make this score a useful tool for assessing the effects of therapeutic maneuvers for pediatric asthmatic patients.

DISCLOSURE: C.L. Carroll, None.