Maekawa Takanobu, Ohya Yukihiro, Mikami Masashi, Uematsu Satoko, Ishiguro Akira
Division of Pediatrics, Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.
Division of Allergy, Department of Medical Subspecialties, National Center for Child Health and Development, Tokyo, Japan.
JMA J. 2018 Sep 28;1(1):57-66. doi: 10.31662/jmaj.2018-0010.
The Modified Pulmonary Index Score (MPIS) was developed as an objective assessment tool for acute asthma exacerbation in children. Although it is considered reliable, there are no known studies of its clinical utility. The objective of this study was to evaluate the validity of the MPIS for children with acute asthma in a clinical setting.
In this retrospective study conducted between July 2009 and June 2011 using electronic medical records at the emergency department of a single pediatric medical center in Tokyo, Japan, the MPIS was recorded for patients with acute asthma at initial assessment and after treatment with an inhaled beta-agonist. We evaluated the responsiveness and predictive validity of the MPIS using disposition as an outcome.
A total of 2242 patients were assessed using the MPIS (median age, 3 years; 71.2% patients were 5 years or younger). The mean (SD) MPIS at initial assessment was 7.1 (3.6) and was significantly higher for the admission group than for the non-admission group (9.9 [2.9] vs. 5.9 [3.1]; < 0.001). The receiver operator characteristic curve of the initial MPIS for hospital admission demonstrated moderate predictive ability (area under the curve, 0.83). An MPIS reduction of 3 or more indicated a clinically significant change when the MPIS at initial assessment was between 6 and 10 (risk ratio for admission [95% CI], 0.41 [0.28-0.60]; < 0.001).
The MPIS demonstrated good concurrent validity, predictive validity, and responsiveness in a wide range of clinical settings.
改良肺指数评分（MPIS）是作为评估儿童急性哮喘加重的一种客观工具而开发的。尽管它被认为是可靠的，但尚无关于其临床效用的研究。本研究的目的是在临床环境中评估MPIS对急性哮喘儿童的有效性。
在2009年7月至2011年6月期间，利用日本东京一家儿科医疗中心急诊科的电子病历进行的这项回顾性研究中，对急性哮喘患者在初始评估时以及吸入β受体激动剂治疗后记录MPIS。我们以处置情况作为结果评估MPIS的反应性和预测有效性。
共有2242例患者使用MPIS进行评估（中位年龄3岁；71.2%的患者年龄在5岁及以下）。初始评估时MPIS的平均（标准差）为7.1（3.6），入院组显著高于非入院组（9.9 [2.9] 对5.9 [3.1]；<0.001）。初始MPIS对住院的受试者工作特征曲线显示出中等预测能力（曲线下面积为0.83）。当初始评估时MPIS在6至10之间时，MPIS降低3分或更多表明有临床显著变化（入院风险比[95%CI]，0.41 [0.28 - 0.60]；<0.001）。
MPIS在广泛的临床环境中显示出良好的同时效度、预测效度和反应性。
