Abstract
Background:
The American Thoracic Society (ATS) guides spirometry standards to ensure that results are accurately interpreted and influence care appropriately. In 2019, ATS/ERS standards replaced the 2005 ATS standards and redefined criteria by removing the time requirement and implementing a grading system to allow more acceptable spirometry tests (Table 1). A study of 1,631 children found that only 18% were able to meet the end of test time requirement set by the 2005 ATS standards.1 We hypothesized that there would be an increase in acceptable spirometry for pediatric patients in our facility when using the 2019 ATS guidelines for spirometry compliance.
Methods:
In an IRB approved retrospective analysis, we reviewed and compared pediatric spirometry (n = 5,400) from 1/2019–12/2020. 20% (n = 1,080) of spirometry tests were chosen at random, audited, and then categorized based on patient age. Spirometry audits were analyzed for compliance based on 2005 and 2019 ATS standards criteria. Results were analyzed and the Student’s t-test was used to determine statistical significance.
Results:
1,080 pediatric spirometry audits were reviewed; the age range of patients was 6–18 y (median 11.3 y). When comparing spirometry compliance with 2005 and 2019 ATS Standards, compliance was increased by 15.3% when using the 2019 ATS Standards (P <0.001) (Figure 1).
Conclusions:
In our pediatric hospital, introduction of the 2019 ATS Standards has led to a significant increase in acceptable spirometry. By eliminating the required minimum time for each maneuver and implementing a grading system to represent confidence level of each spirometry test performed by the patient, more acceptable and valid data can be used by the clinician to appropriately treat patients who may not have been able to produce acceptable spirometry in the past. Further studies must be done to evaluate the impact to patient care decisions that occur after spirometry is completed. Reference: Graham BL, et al. Standardization of spirometry 2019 update. An official American Thoracic Society and European Respiratory Society technical statement. Am J Respir Crit Care Med 2019;200 (8):e70-e88.
Table 1 shows the percentage of compliance and acceptability with the 2005 ATD standards compared with the 2019 ATS standards for pediatric spirometry in our facility based on breakdown of age.
Figure 1 shows details the 2005 and 2015 ATS standards for acceptable spirometry. View all access options for this article.Compliance To Standard by Age
2005 ATS Standards (%)
2019 ATS Standards (%)
Change (%)
Significance
Total (n=1080)
59.7
75
+15.3
p<0.00001
Age 6 (n=76)
32.9
52.6
+19.7
p<0.01
Age 7 (n=91)
53.8
63.7
+9.9
p<0.1
Age 8 (n=116)
59.4
80.2
+20.8
p<0.001
Age 9 (n=133)
72.9
85
+12.1
p<0.01
Age 10 (n=107)
54.2
78.5
+24.3
p<0.0001
Age 11 (n=107)
67.2
82.2
+15
p<0.01
Age 12 (n=93)
75.3
90.3
+15
p<0.01
Age 13 (n=83)
51.8
79.5
+27.7
p<0.0001
Age 14 (n=71)
46.5
78.9
+32.4
p<0.0001
Age 15 (n=51)
41.2
80.4
+39.2
p<0.0001
Age 16 (n=68)
75.3
86.8
+13.3
p<0.05
Age 17 (n=52)
67.3
86.5
+19.2
p<0.05
Age 18 (n=32)
71.9
87.5
+15.6
p<0.10
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