RESUMO
BACKGROUND: Acute exacerbations of asthma are common in children. Multiple asthma severity scores exist, but current emergency department (ED) use of severity scores is not known. METHODS: A systematic review was undertaken to identify the parameters collected in pediatric asthma severity scores. A survey of Paediatric Emergency Research in the United Kingdom and Ireland (PERUKI) sites was undertaken to ascertain routinely collected asthma data and information about severity scores. Included studies examined severity of asthma exacerbation in children 5-18 years of age with extractable severity parameters. RESULTS: Sixteen articles were eligible, containing 17 asthma severity scores. The severity scores assessed combinations of 15 different parameters (median, 6; range, 2-8). The most common parameters considered were expiratory wheeze (15/17), inspiratory wheeze (13/17), respiratory rate (10/17), and general accessory muscle use (9/17). Fifty-nine PERUKI centers responded to the questionnaire. Twenty centers (33.1%) currently assess severity, but few use a published score. The most commonly recorded routine data required for severity scores were oxygen saturations (59/59, 100%), heart rate, and respiratory rate (58/59, 98.3% for both). Among well-validated scores like the Pulmonary Index Score (PIS), Pediatric Asthma Severity Score (PASS), Childhood Asthma Score (CAS), and the Pediatric Respiratory Assessment Measure (PRAM), only 6/59 (10.2%), 3/59 (5.1%), 1/59 (1.7%), and 0 (0%) of units respectively routinely collect the data required to calculate them. CONCLUSION: Standardized published pediatric asthma severity scores are infrequently used. Improved routine data collection focusing on the key parameters common to multiple scores could improve this, facilitating research and audit of pediatric acute asthma.
RESUMO
OBJECTIVE: Evaluating Health Information Technologies (HITs) can be challenging, but studies are necessary so that the most beneficial interventions can be identified. Our objective was to systematically review the available recommendations for improving the methods used in HIT evaluations. METHODS: HIT evaluation frameworks were identified from database (MEDLINE, EMBASE, CINAHL) and grey literature searches. Outcome measures included framework recommendations and characteristics. Recommendations were coded and organised using thematic analysis methods. A scoring instrument was used to measure framework quality. RESULTS: The search identified 23 frameworks and 272 recommendations. These were organised into five evaluation domains and 42 themes. The themes included recommendations for improving the evaluation of technical aspects of HITs (e.g. describing aspects of HIT functionality) and suggestions for improving the evaluation of complex factors that may influence the overall effects of HITs (e.g. careful reporting of whether the HIT became integrated into existing working patterns). The frameworks were not generally developed in association with healthcare professionals, or with input from patients. The frameworks tended not to have been developed using systematic methods designed to reduce the risk of bias. DISCUSSION: HIT evaluations are important but they are challenging to conduct and appraise. This review was conducted using systematic methods enabling the organisation of framework recommendations into key themes. These findings may help investigators to successfully plan, conduct and appraise HIT evaluations. The quality appraisal demonstrated that HIT evaluation research may be improved by using more systematic methods and the involvement of participants from a range of differing backgrounds.