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UKK: Respiratory
Category: ePoster Presentation
Code: P - RES - 021

Validation of asthma attack scoring system with peak

expiratory flow rate in children with asthma attack in
RSUD Dr. Soetomo
Hidayati Utami Dewi, Retno Asih Setyoningrum(1)

Department of Child Health, Faculty of Medicine, Universitas Airlangga/ Dr. Soetomo Hospital Surabaya,
Indonesia (1)

Background: Accurate measurement of the degree of airway obstruction is very important to guide
therapy and management of asthma attacks. The degree of airway obstruction is objectively assessed by
spirometry or peak flow meter which measures the peak expiratory flow rate (PEFR), but the use and
measurement with the tool requires special expertise. Clinical scores asthma attack is a convenient tool to
measure the degree of obstruction, but the use and validation of a scoring system has not been done in Dr.
Soetomo hospital.

Objective: To validate four clinical scoring system for children with asthma attacks.
Method: A Cross-sectional study of children aged 5-14 years with asthma attacks, performed in outpatient
clinic and emergency department of Dr. Soetomo hospital and Airlangga University hospital Surabaya.
Subjects was assessed using four asthma scoring system and confirmed with a peak flow meter. Statistical
analysis using correlation, discrimination and diagnostic tested, with p<0.05 considered as significant.
Result: Pediatric Respiratory Assessment Measure (PRAM) had strong correlation with PEFR (r=0.702,
p=0.001), good value of discrimination with AUC 0.88 (95% CI 0.795-0.964), sensitivity 92.0% and specificity
80.0% in determining airway obstruction. Pediatric Asthma Severity Score (PASS) had no correlation with
PEFR (r=0.005; p=0.970), very weak value of discrimination with AUC 0.46 (95% CL 0.324- 0.603), sensitivity
69.0% and specificity 35%. Pulmonary Score (PS) had weak correlation with PEFR (r=0.590; p=0.001), weak
discrimination value with AUC 0.815 (95% CL 0.705-0.925), sensitivity 92% and specificity 30%. Asthma
Severity Scale (ASS) had very weak correlation with PEFR (r=0.386; p=0.001), moderate value of
discrimination with AUC 0.738 (95% Cl 0.795-0.964), sensitivity 88% and specificity 37% in determining
airway obstruction.

Conclusion: Pediatric Respiratory Assessment Measure (PRAM) system is valid in determining the degree of
airway obstruction in children with asthma attacks compared with PEFR.
Keyword : asthma attack, asthma scoring system, PRAM, PEFR, PASS