Pediatric Asthma Score

Assess severity of acute asthma exacerbation in pediatric patients aged 1–18 years to guide treatment decisions and disposition

Indication

Assess severity of acute asthma exacerbation in pediatric patients aged 1–18 years to guide treatment decisions and disposition

id: respiratory_rate; label: Respiratory Rate; type: options; options: value: 0; label: Normal for age; value: 1; label: Mildly increased (≤50% above normal); value: 2; label: Moderately increased (>50% above normal); value: 3; label: Severely increased or <8 breaths/min (fatigue); reference: Normal RR by age: <2yr: <50/min | 2–5yr: <40/min | 6–12yr: <30/min | >12yr: <20/min
id: oxygen_saturation; label: Oxygen Saturation on Room Air; type: options; options: value: 0; label: >95%; value: 1; label: 90–95%; value: 2; label: <90%
id: auscultation; label: Auscultation; type: options; options: value: 0; label: Normal breath sounds or mild end-expiratory wheeze; value: 1; label: Expiratory wheeze; value: 2; label: Inspiratory and expiratory wheeze; value: 3; label: Diminished breath sounds or silent chest
id: retractions; label: Retractions; type: options; options: value: 0; label: None; value: 1; label: Intercostal only; value: 2; label: Intercostal and subcostal; value: 3; label: Intercostal, subcostal, and suprasternal/supraclavicular
id: dyspnea; label: Dyspnea (ability to speak or cry); type: options; options: value: 0; label: Speaks in sentences or coos/babbles normally; value: 1; label: Speaks in phrases (older child) or shortened cry; value: 2; label: Speaks in words only or short cry; value: 3; label: Unable to speak or cry

function(score) { if (score <= 4) return { risk: 'Mild', tier: 'low', action: 'Mild exacerbation. Albuterol 2.5mg nebulized q20min \u00D7 3 doses (or MDI 4\u20138 puffs). Reassess after each treatment. Consider single dose oral dexamethasone 0.6mg/kg (max 10mg). Discharge if responds well.', color: 'green', }; if (score <= 8) return { risk: 'Moderate', tier: 'medium', action: 'Moderate exacerbation. Albuterol 2.5\u20135mg nebulized q20min \u00D7 3 doses + ipratropium 250\u2013500mcg q20min \u00D7 3 doses. Oral or IV dexamethasone 0.6mg/kg (max 10mg). Reassess frequently. Likely admission if incomplete response.', color: 'yellow', }; return { risk: 'Severe', tier: 'high', action: 'Severe exacerbation. Continuous albuterol nebulization. IV/IM dexamethasone or methylprednisolone 1\u20132mg/kg. IV magnesium sulfate 50mg/kg (max 2g) over 20 min. Consider heliox. Prepare for possible intubation. PICU consultation. Admit.', color: 'red', }; }

A silent chest is a medical emergency — absent breath sounds means air movement is so poor that wheezing cannot be generated. Immediate aggressive intervention and PICU involvement required.
Dexamethasone 0.6mg/kg single dose is as effective as a 5-day prednisolone course and dramatically improves compliance — preferred in most pediatric ED settings.
Magnesium sulfate IV is a bronchodilator that works by blocking calcium-mediated smooth muscle contraction — use for moderate-severe asthma not responding to initial therapy.
Reassess score after every treatment cycle — improvement in score guides discharge vs admission decision more reliably than a single assessment.
If intubation is required in a severe asthmatic, use ketamine for induction (bronchodilator), accept permissive hypercapnia, and use low respiratory rates to allow full exhalation and prevent air trapping.

Gorelick MH et al. Pediatric Emergency Care 2004; GINA Pediatric Asthma Guidelines 2023. Last reviewed: 2024-11-01