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Psychometric properties of scales used for grading the severity of bronchial obstruction in pediatrics: A systematic review and meta-analysis

Luarte-Martinez, S., Rodriguez-Nunez, I., Astudillo, P., and Manterola, C.
INTRODUCTION: In pediatrics, identifying the severity of bronchial obstruction in an early manner is a decisive factor.

OBJETIVE: To assess the psychometric properties of the scales for grading the severity of bronchial obstruction in pediatric patients.

POPULATION AND METHOD: This was a systematic review of studies on the validity and reliability of scales for grading the severity of bronchial obstruction conducted in infants and children younger than 3 years old. The search was conducted in Medline, WoS, EMBASE, SciELO, and Google Scholar. The correlation coefficient corresponding to each article was included in a random effects model to establish the criterion validity and reliability using the weighted averages of coefficients as per the sample size.

RESULTS: A total of 9 articles were included, which accounted for 2699 children; 3 articles had an adequate or excellent methodological quality. Four articles established the concurrent criterion validity considering oxygen saturation, with a weighted correlation coefficient of -0.627 (95% confidence interval [CI]: -0.767 to -0.431, p < 0.001); 2 articles established the convergent criterion validity, with a weighted correlation coefficient of 0.809 (95%

CI: 0.721 to 0.871, p < 0.001); 6 articles established the inter-observer reliability, with a weighted correlation coefficient of0.500for kappa and 0.891 for the intraclass correlation coefficient.

CONCLUSION: The assessment of psychometric properties to support the use of scales for grading the construct "severity of bronchial obstruction" showed a moderate to adequate criterion validity. The percentage of agreement among observers in terms of the studied measure (severity of bronchial obstruction) was adequate; however, weaknesses such as the article design should be taken into account since it may affect the internal validity of results.
Arch Argent Pediatr
Publication year:
Biological and physiological variables:
Biological and physiological variables
Symptom status:
Physical state
Children (0-18)
Diseases of and symptoms related to the respiratory system
PRO / non-PRO:
Non-patient Reported Outcome
Type of measurement instrument:
6 - Clinical rating scales
7 - Observations
CAS - Clinical Asthma Score (versions: mCAS)
CHWRS - Children’s Hospital of Wisconsin Respiratory Score
RDAI -Respiratory Distress Assessment Index/Instrument (versions: mRDAI)
RDSMoHA - Respiratory distress scale by the Ministry of Health of Argentina
Respiratory Score (versions: WRS - Wang RS; KRS - Kristjansson; Gadjos RS)
Tal Score (versions: mTal; TSMc; TSP)