Adapting an Evidence-based Pediatric Acute Asthma Exacerbation Severity Assessment Tool for Pediatric Primary Care

Anne T. Magpuri, DNP, MSN, BSN, APRN, CPNP-PC; Jane K. Dixon, PhD; Ruth McCorkle, PhD, RN, FAAN; Angela A. Crowley, PhD, APRN, PNP-BC, FAAN

Disclosures

J Pediatr Health Care. 2018;32(1):10-20. 

In This Article

Abstract and Introduction

Abstract

Introduction The purposes of this project were (a) to examine criteria derived from evidence-based pediatric acute asthma exacerbation assessment tools, asthma scores, and the acute asthma prediction rule validated and used in the emergency department and (b) to adapt these criteria for pediatric primary care.

Method The three stages of the project included (a) identification of criteria in a literature review, (b) validation of the criteria by an expert panel, and (c) adaptation of the criteria in the design of an assessment tool.

Results The criteria were validated and adapted in the design of The Pediatric Acute Asthma Exacerbation Severity Assessment and Disposition Decision-Making Tool for Pediatric Primary Care.

Discussion The adaptation of criteria derived from the evidence and validated by an expert panel will inform and guide clinicians in assessing severity and support decision making in determining disposition of pediatric patients presenting with an acute asthma exacerbation in primary care.

Introduction

In the past two decades, children ages 5 to 17 years old have had the highest asthma prevalence rates and the highest exacerbation prevalence rates across all ages. In 2011, 4 million children younger than 18 years old had an exacerbation, 77% of whom were ages 5 to 17 years old (American Lung Association, 2012). Rapid management and treatment must be initiated in children with severe or life-threatening exacerbations (U.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute, & National Asthma Education and Prevention Program, 2007). Clinical signs and symptoms are critical to determining the severity level of an exacerbation in a child. The emergency department (ED) management of moderate to severe acute asthma exacerbations requires an assessment tool to measure the severity of asthma to provide effective treatment (Van der Windt, Nagelkereke, Bouter, Danker-Roelse, & Veerman, 1994). "Given that pulmonary function testing in the preschool children is often neither feasible nor reliable, many clinical scores of asthma severity have been developed" (Birken, Parkin, & MacArthur, 2004, p. 1177).

Because many pediatric patients also present with acute asthma exacerbations in primary care settings, there is a need to implement such tools to guide primary care providers. Such evidence-based asthma assessment tools provide essential guidance for providers assessing severity level, initiating treatment, and determining disposition of pediatric patients with acute asthma exacerbation in primary care. "The ability to quickly and accurately evaluate acute asthma exacerbation severity is essential for providing appropriate, quality care in an efficient manner" (O'Connor, Berg, Stack, & Arnold, 2015, p. 1). Furthermore, use of an evidence-based asthma assessment tool has the potential to increase patient safety, improve quality of care, and expedite patient flow in the primary care setting. Our purpose was to describe the validation and adaptation of criteria used in the design of the Pediatric Acute Asthma Exacerbation Severity Assessment and Disposition Decision-Making Tool for Pediatric Primary Care.

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