Make an M-PACT on asthma: rapid identification of persistent asthma symptoms in a pediatric emergency department

Pediatr Emerg Care. 2010 Jan;26(1):1-5. doi: 10.1097/PEC.0b013e3181c32e9d.


Objective: To develop and validate a brief assessment instrument for persistent asthma symptoms in a pediatric emergency department (ED) population.

Methods: Parents of children aged 1 to 18 years being discharged home after treatment for acute asthma in an urban children's hospital completed a 6-item screen for persistent symptoms that had been developed from national guidelines and previously validated. During a follow-up phone call 4 weeks after the ED visit, the instrument was repeated. An 8-item asthma-related quality-of-life (ARQOL) instrument was also administered at both times to assess construct validity. Item analysis assessed the performance of individual items and their combination versus the full instrument.

Results: Four hundred thirty-three children were enrolled, and 361 patients (83%) had complete data. Sensitivity and predictive value were calculated for the full screen and combination of items in detecting persistent symptoms at baseline and follow-up. A 3-item version included symptoms with activity, symptoms at night, and need for rescue albuterol. This version was 96% sensitive (95% confidence interval, 92-99) for persistent symptoms compared with the 6-item screen, and 69% (95% confidence interval, 62-76) of the participants continued to report persistent symptoms 4 weeks after the visit. For both screens, subjects with persistent symptoms had significantly worse ARQOL score at baseline and follow-up.

Conclusions: A brief screen can identify persistent symptoms in pediatric ED patients with good sensitivity compared with a longer instrument. Most of these patients will continue to report persistent symptoms and reduced ARQOL score 1 month after the ED visit and may be candidates for additional interventions in the ED to improve long-term asthma care.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Anti-Asthmatic Agents / therapeutic use
  • Appointments and Schedules
  • Asthma / diagnosis
  • Asthma / epidemiology
  • Asthma / therapy*
  • Child
  • Child, Preschool
  • Female
  • Follow-Up Studies
  • Hospitals, Pediatric*
  • Humans
  • Infant
  • Intensive Care Units, Pediatric*
  • Male
  • Prospective Studies
  • Quality of Life
  • Severity of Illness Index
  • Treatment Outcome
  • Urban Population


  • Anti-Asthmatic Agents