Pediatric Asthma Score (PAS)

Pediatric Asthma Score

Respiratory Rate

Oxygen Requirement

Auscultation

Retractions

Dyspnea

Score:–

–

Stratifies asthma severity in children.

Why Use

Asthma is the most common reason for hospital admission from the emergency department in children. When combined with a treatment protocol based on severity, the PAS has been shown to decrease length of stay, reduce costs, and improve quality of care.

When to Use

Use in children aged 2-18 years with asthma exacerbation to guide inpatient medical management. Can also be applied in the emergency department. Should not be used to evaluate patients with significant comorbidities (e.g. sickle cell disease, cystic fibrosis).

Formula

Addition of the selected points: 1 point 2 points 3 points Respiratory Rate by Age 2-3 years ≤34 35-39 ≥40 4-5 years ≤30 31-35 ≥36 6-12 years ≤26 27-30 ≥31 >12 years ≤23 24-27 ≥28 Oxygen Requirements >95% on room air 90-95% on room air <90% on room air or any supplemental oxygen Auscultation Normal breath sounds to end-expiratory wheeze only Expiratory wheezing Inspiratory and expiratory wheezing to diminished breath sounds Retractions None or intercostal Intercostal and substernal Intercostal, substernal, and supraclavicular Dyspnea Speaks in sentences (or coos and babbles) Speaks partial sentences (or short cry) Speaks in single words or short phrases (or grunts)

Pearls / Pitfalls

The PAS was evaluated based on patients that had already received oral or IV steroids within 30 minutes of treatment initiation. Helpful in patients unwilling or unable to comply with peak expiratory flow measurement. May quantify severity of asthma, but cannot predict response to treatment prior to intervention. Good inter-observer agreement among physicians, nurses, and respiratory therapists in an ED setting. Developed based on published guidelines of the National Asthma Education and Prevention Program in an effort to improve outcomes.

Management

The authors used a therapy-driven protocol derived from review of asthma practice patterns in the hospital, NHLBI guidelines, and a review of literature regarding inpatient management of status asthmaticus. The protocol was designed to use either the PAS or PEFR to measure response. Another example of a pathway for management of asthma in the inpatient setting: Children's Hospital of Philadelphia Inpatient Asthma Pathway

Critical Actions

Always assess airway, breathing, and circulation prior to assessing PAS. The PAS was not developed for use on unstable patients and emergent intervention must not be withheld to determine the score. Any patient being treated for asthma exacerbation should receive steroids in addition to nebulized albuterol unless there is a contraindication. Prior to discharge, every patient and their family should receive education on use of home inhalers and/or nebulizers, an asthma action plan, and scheduled follow-up with their primary care physician. Ensure the patient has adequate supply of home controller medications, peak flow meter, and spacer if applicable.

Advice

Mild (PAS 5-7) Consider de-escalation of current therapy. Consider spacing of albuterol and interval assessments, or preparation for discharge if tolerating home controller regimen. Moderate (PAS 8-11) Continue current treatment and interval assessment. Severe (PAS 12-15) Consider escalation of treatment, including increasing frequency of nebulizer treatments, adding another controller medication (e.g. ipratropium bromide, terbutaline), and transfer to monitored unit.

More Information

Interpretation: Pediatric Asthma Score (PAS) Severity of Exacerbation Percent of Peak Flow (Personal Best or Predicted) 5-7 Mild >70% 8-11 Moderate 50-70% 12-15 Severe <50%