Childhood asthma risk prediction - clinician judgement versus Pediatric Asthma Risk Score as a clinical decision support tool

<bold>Background:</bold> Although effective therapeutic interventions for childhood asthma exist, delayed identification of high-risk children in need of early intervention remains prevalent. <bold>Objective:</bold> Determine the proportion of clinicians at one health network in Indiana, United States who can correctly classify risk of school-age asthma based on a case study and evaluate clinician confidence, intentions to use, and acceptance of the Pediatric Asthma Risk Score (PARS) as a clinical decision support (CDS) tool. <bold>Methods:</bold> Blinded to the PARS, pediatrician clinicians (N=139) were asked to predict the risk of school-age asthma of a three-year old categorized as ‘high risk’ by the PARS (i.e., case study) based on their professional judgement. Unblinded to PARS, clinicians also rated their confidence in their professional judgement (versus PARS), intentions to use and accept the PARS. <bold>Results:</bold> Compared to the PARS, 1 in 4 clinicians underestimated the risk of school-age asthma. More clinicians reported low confidence in their own professional judgement than the PARS risk classification (52% vs 7%, p<0.01). Clinicians who reported low confidence in their professional judgement had higher odds (adjusted odds ratio: 3.71; 95%CI: 1.55, 8.88) of underestimating asthma risk but lower intentions to use and accept the PARS as a CDS tool (p<0.01) than clinicians who reported higher self-confidence. Discussion: Underestimation of childhood asthma risk may be correlated with low clinician confidence in their ability to predict risk. Strategies to increase clinician confidence using the PARS may be key to early identification and intervention to address the burden of childhood asthma.