Pediatric Dyspnea Scale for use in hospitalized patients with asthma

• Published in: Journal of allergy and clinical immunology Vol. 123; no. 3; pp. 660 - 664
• Main Authors: Khan, Farah I., MD, Reddy, Raju C., MD, Baptist, Alan P., MD, MPH
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-03-2009; Elsevier; Elsevier Limited
• Subjects: Adolescent; Allergy and Immunology; Asthma; Asthma - complications; Asthma - physiopathology; Biological and medical sciences; Child; Decision making; discharge; dyspnea; Dyspnea - etiology; Dyspnea - physiopathology; exhaled nitric oxide; Female; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Hospitalization; hospitalized; Hospitals; Humans; Immunopathology; Male; Medical sciences; Nitric Oxide; outcome; Patient Discharge; pediatric; Pneumology; Quality of Life; Respiratory system : syndromes and miscellaneous diseases; Risk Factors; Sarcoidosis. Granulomatous diseases of unproved etiology. Connective tissue diseases. Elastic tissue diseases. Vasculitis; scale; Severity of Illness Index; spirometry; symptoms; ATS; FeNO; Fraction of exhaled nitric oxide; scale; Integrated Therapeutics Group–Child Asthma Short Form; National Institutes of Health; Intensive care unit; pediatric; hospitalized; Pediatric Dyspnea Scale; Emergency department; discharge; exhaled nitric oxide; CHOM; outcome; PDS; Asthma Control Test; ED; ITG-CASF; OR; PEFR; dyspnea; NIH; Asthma; symptoms; American Thoracic Society; ACT; spirometry; Peak expiratory flow rate; Children's Hospital of Michigan; Odds ratio; ICU; Pediatrics; Spirometry; Prognosis; Dyspnea; Immunology; Bronchus disease; Evolution; Obstructive pulmonary disease; Child; Human; Lung disease; Immunopathology; Respiratory disease; Use; Expiration; Exploration; Hospitalization; Symptomatology; Nitric oxide; Respiration
• ISSN: 0091-6749; 1097-6825
• DOI: 10.1016/j.jaci.2008.12.018

Background Asthma is a leading cause of pediatric hospitalizations across the country, yet no clinical instrument exists that incorporates the child's perception of dyspnea in determining discharge readiness. Objective We sought to develop the Pediatric Dyspnea Scale (PDS) to support discharge decision making in hospitalized asthmatic patients and to compare the performance of the PDS with traditional markers of asthma control in predicting outcomes after discharge. Methods Asthmatic children aged 6 to 18 years hospitalized for an exacerbation were included in the study. The PDS score, demographics, asthma severity, spirometric results, peak expiratory flow rate, and fraction of exhaled nitric oxide were assessed at the time of discharge. A telephone call 14 days after discharge determined relapse, activity limitation, asthma control, and asthma-related quality-of-life outcomes. Results Eighty-nine patients were enrolled, of whom 70 completed the telephone follow-up. Eight patients had a relapse, and 29 complained of limited activity. A PDS score of greater than 2 on the 7-point scale was a significant predictor of these poor outcomes, with each additional point of the PDS doubling the risk. A higher score on the PDS also correlated with worse asthma control and poor asthma-specific quality of life. The PDS performed better than FEV1 , peak expiratory flow rate, or fraction of exhaled nitric oxide in predicting the outcomes of interest. Conclusion The PDS, which is easy to use in children as young as 6 years of age, might be able to predict adverse outcomes after hospitalization for an asthma exacerbation and should be used as a tool to help guide inpatient discharge decisions.