A modified Pulmonary Index Score with predictive value for pediatric asthma exacerbations

Background: Several clinical asthma scores have been derived from combinations of physical findings in pediatric asthmatic patients. Objective: To test the reproducibility and validity of one such score, the Modified Pulmonary Index Score (MPIS), and to evaluate its predictive value in children hospitalized for asthma. Methods: In the MPIS, 6 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 6 measurements or observations, a score of 0 to 3 is assigned. To evaluate the reproducibility of the MPIS, inpatients with status asthmaticus were examined by an attending physician, nurse, and respiratory therapist who were blinded to the other observers' scores. To evaluate 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 patients. Results: A total of 30 patients participated in this study (mean +/- SD age, 7.6 5.5 years). Our finding revealed that the MPIS is highly reproducible with a high degree of interrater reliability across caregiver groups (physician to nurse: r = 0.98; 95% confidence interval [CI], > 0.96; physician to respiratory therapist: r = 0.95; 95% CI, > 0.92; nurse to respiratory therapist: r = 0.94; 95% CI, > 0.90). The admission MPIS positively correlated with intensive care unit admission (P < .001), days of continuous albuterol therapy (P = .002), days of supplemental oxygen (P = .002), and length of hospital stay (P = .004). Conclusions: The MPIS is a highly reproducible and valid indicator of severity of illness in children with asthma. To our knowledge, this is the first pediatric clinical asthma score demonstrated to be reproducible across groups of health care professionals who treat pediatric patients with asthma.