The Clinical Respiratory Score: investigating the reliability of an asthma scoring tool across a multidisciplinary team

Abstract

Background

Asthma scoring tools are used by emergency department (ED) teams to communicate severity of illness. Although most have been validated, none has been found to be sufficiently valid to allow for use across a multidisciplinary team managing pediatric asthma exacerbations.

Objective

We sought to evaluate the inter-rater reliability of the Clinical Respiratory Score (CRS) among all members of an ED care team.

Design/Methods

We conducted a retrospective study of children aged 2 to 18 years presenting with an acute asthma exacerbation to an urban pediatric ED over a 2-year period. We determined reliability using two CRS measurements independently documented by two separate providers, 15 min apart. An inter-class correlation coefficient (ICC) was calculated to determine overall reliability among users. Subgroup analysis was conducted to determine reliability between types of providers and the six components of the CRS.

Results

A total of 9,749 patient encounters were identified and 1,562 (16%) met our inclusion criteria. The majority of score pairings (n = 1096, 70.2%) were documented by a registered nurse followed by a respiratory therapist. The overall reliability of the CRS, when documented by two providers, was acceptable with an ICC of 0.76 (95% CI: 0.74-0.78, p < 0.001). Removing CRS components with the lowest agreement did not affect the overall ICC when re-calculated.

Conclusion(s)

The CRS is a reliable asthma severity scoring tool for pediatric patients presenting with an acute asthma exacerbation when utilized across care team members. Simplifying the CRS by removing the color and mental status components did not affect its reliability.

Keywords:

• Asthma
• pediatric emergency department
• severity score
• Clinical Respiratory Score

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Prior presentation

Poster format at Pediatric Academic Societies meeting on May 5, 2018

Funding

The author(s) reported there is no funding associated with the work featured in this article.