Birken Catherine S, Parkin Patricia C, Macarthur Colin
Division of Paediatric Medicine, Paediatric Outcomes Research Team, The Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, M5G 1X8 Canada.
J Clin Epidemiol. 2004 Nov;57(11):1177-81. doi: 10.1016/j.jclinepi.2004.02.016.
To evaluate the measurement properties of asthma severity scores for use in preschool children.
A Medline search was used to identify published asthma severity scores for use in preschool children. The measurement properties of the scores (item development, reliability, validity, responsiveness, and usability) were evaluated using a published framework.
Ten asthma severity scores were identified, with 19 different clinical variables used as items. Interrater agreement was assessed by five scores. Only two scores--Clinical Asthma Score (CAS) and Respiratory Distress Assessment Index (RDAI)--reported good agreement based on weighted kappa-statistics (0.64-0.90). Construct validity was reported by the CAS, Clinical Asthma Evaluation Score (CAES), the Clinical Symptom Grading System (CSGS), and the Preschool Respiratory Assessment Measure (PRAM). Correlation coefficients between asthma severity scores and clinical measures (length of stay, drug dosing interval, O2 saturation, health professional assessment, PaO2, PaCO2) ranged from 0.47 to 0.70. Responsiveness was formally demonstrated for two scales (PRAM, CAS).
Most asthma severity scales for use in preschool children have been informally developed. Recently developed scores (CAS, PRAM) have more rigorously evaluated their measurement properties. Research is needed to directly compare the asthma severity scores developed for use in preschool children.
评估用于学龄前儿童的哮喘严重程度评分的测量属性。
通过检索医学文献数据库（Medline）来确定已发表的用于学龄前儿童的哮喘严重程度评分。使用已发表的框架对这些评分的测量属性（条目开发、信度、效度、反应度和可用性）进行评估。
共识别出10个哮喘严重程度评分，其中使用了19个不同的临床变量作为条目。通过5个评分评估了评分者间的一致性。基于加权kappa统计量（0.64 - 0.90），只有两个评分——临床哮喘评分（CAS）和呼吸窘迫评估指数（RDAI）——报告了良好的一致性。临床哮喘评分（CAS）、临床哮喘评估评分（CAES）、临床症状分级系统（CSGS）和学龄前呼吸评估指标（PRAM）报告了结构效度。哮喘严重程度评分与临床指标（住院时间、给药间隔、血氧饱和度、医疗专业人员评估、动脉血氧分压、动脉血二氧化碳分压）之间的相关系数范围为0.47至0.70。正式证明了两个量表（PRAM、CAS）具有反应度。
大多数用于学龄前儿童的哮喘严重程度量表是未经正式开发的。最近开发的评分（CAS、PRAM）对其测量属性进行了更严格的评估。需要开展研究以直接比较为学龄前儿童开发的哮喘严重程度评分。
