PURPOSE: To evaluate the interobserver agreement in the use of a novel standardized scoring system of severity of acute lower airway obstruction due to asthma, bronchiolitis and related disorders.
METHODS: The scoring system, devised by the authors (ACK), consisted of four categories: A:Aeration (presence and quality of breath sounds), B:Bronchospasm (presence and characteristics of wheezing), C:Chest wall retractions (type of respiratory muscles involved), D:Desaturation (level of oxyhemoglobin desaturation on room air). Each category was subdivided in 4 well defined subcategories scored from 1 (normal) to 4 (severe). The severity of the patients’ condition was based on the total score: “mild”: total score of 5-8, “moderate”: 9-12, “severe”: 13-16. Fifty inpatients in a tertiary care children's hospital, ages 4 months to 18 years with the diagnoses of asthma/RAD and bronchiolitis, were scored independently by the pediatric resident and nurse responsible for their care. Comparisons of the scores given by the residents and the nurses in each of the categories were made with the paired t-test.
RESULTS: The total scores were very similar between the residents and the nurses± (6.1 ± 2.4 v. 5.8±2.0). In the individual categories there was no difference in categories A (1.5±0.8 v. 1.4±0.8) and B (1.4±0.6 v. 1.5±0.8). There was statistically significant difference in categories C (1.2±0.6 v. 1.7±1.1, p<0.05) and D (1.7±1.1 v. 1.6±1.0, p<0.05). Overall, the scores were identical between residents and nurses in 23 patients and differed by only 1 point in additional 18 patients. Difference in the level of severity occured only in 3/50 patients.
CONCLUSION: The differences in scoring in the individual categories may reflect differences in skill or experience between observers, or changes in the patients’ condition. On the other hand, the 94% agreement on the severity score suggests that our scoring is an easy to use, objective system with practical clinical applications.
CLINICAL IMPLICATIONS: A reliable standardized scoring system would facilitate the delivery of consistent, quality care. The scoring could be used for the evaluation of treatment modalities and pathways and for the comparison of their outcomes.
DISCLOSURE: Anastassios Koumbourlis, No Financial Disclosure Information; No Product/Research Disclosure Information