To develop and validate a brief assessment instrument for persistent asthma symptoms in a pediatric emergency department (ED) population.
Parents of children aged 1 to 18 years being discharged home after treatment for acute asthma in an urban children's hospital completed a 6-item screen for persistent symptoms that had been developed from national guidelines and previously validated. During a follow-up phone call 4 weeks after the ED visit, the instrument was repeated. An 8-item asthma-related quality-of-life (ARQOL) instrument was also administered at both times to assess construct validity. Item analysis assessed the performance of individual items and their combination versus the full instrument.
Four hundred thirty-three children were enrolled, and 361 patients (83%) had complete data. Sensitivity and predictive value were calculated for the full screen and combination of items in detecting persistent symptoms at baseline and follow-up. A 3-item version included symptoms with activity, symptoms at night, and need for rescue albuterol. This version was 96% sensitive (95% confidence interval, 92-99) for persistent symptoms compared with the 6-item screen, and 69% (95% confidence interval, 62-76) of the participants continued to report persistent symptoms 4 weeks after the visit. For both screens, subjects with persistent symptoms had significantly worse ARQOL score at baseline and follow-up.
A brief screen can identify persistent symptoms in pediatric ED patients with good sensitivity compared with a longer instrument. Most of these patients will continue to report persistent symptoms and reduced ARQOL score 1 month after the ED visit and may be candidates for additional interventions in the ED to improve long-term asthma care.