Appendix 4: Respiratory Scoring Tools

MPASS

Assign a score of 0, 1, 2, or 3 for each category below.

Oxygenation (Room Air SaO2)

• Score 0: 98% or higher.
• Score 1: 95% to 97%.
• Score 2: 90% to 94%.
• Score 3: 89% or lower.

Auscultation

• Score 0: No wheezing.
• Score 1: End-expiratory wheezing.
• Score 2: Biphasic wheezing.
• Score 3: Wheezing audible without a stethoscope or silent chest.

Retractions

• Score 0: No retractions.
• Score 1: Intercostal retractions or diaphragmatic breathing.
• Score 2: Two of the following: intercostal retractions, suprasternal retractions, diaphragmatic breathing, or nasal flaring in an infant.
• Score 3: Three of the following: subcostal retractions, intercostal retractions, substernal retractions, supraclavicular retractions, or nasal flaring or head bobbing in an infant.

Dyspnea

• Score 0: Absent dyspnea; alert; playful; speaks in complete sentences.
• Score 1: Some dyspnea; normal activity and speech; irritable; coughing after play.
• Score 2: Moderate dyspnea; decreased activity; speaks in 5 to 8 word sentences; not sleeping or eating; coughing after play.
• Score 3: Severe dyspnea; not speaking; grunting; lethargic; stops playing.

Respiratory Rate

Infant (birth to 12 months)

• Score 0: under 60 breaths per minute.
• Score 1: 60 to 80 breaths per minute.
• Score 2: 81 to 99 breaths per minute.
• Score 3: 100 or higher breaths per minute.

Toddler (1 to 2 years)

• Score 0: under 40 breaths per minute.
• Score 1: 40 to 60 breaths per minute.
• Score 2: 61 to 79 breaths per minute.
• Score 3: 80 or higher breaths per minute.

Preschool (3 to 5 years)

• Score 0: under 30 breaths per minute.
• Score 1: 30 to 40 breaths per minute.
• Score 2: 41 to 59 breaths per minute.
• Score 3: 60 or higher breaths per minute.

School age (6 to 12 years)

• Score 0: under 20 breaths per minute.
• Score 1: 20 to 26 breaths per minute.
• Score 2: 27 to 30 breaths per minute.
• Score 3: 31 or higher breaths per minute.

Adolescent (13 to 18 years)

• Score 0: under 18 breaths per minute.
• Score 1: 18 to 23 breaths per minute.
• Score 2: 24 to 27 breaths per minute.
• Score 3: 28 or higher breaths per minute.

MPASS Severity

• Mild: total score 1 to 5.
• Moderate: total score 6 to 10.
• Severe: total score 11 to 15.

Modified Tal Score

Assign a score of 0, 1, 2, or 3 using the criteria below.

Score 0

• Respiratory rate younger than 6 months: 40 breaths per minute or less.
• Respiratory rate 6 months or older: 30 breaths per minute or less.
• Wheezing/crackles: None.
• Oxygen saturation on room air: 95% or higher.
• Accessory respiratory muscle use: None.

Score 1

• Respiratory rate younger than 6 months: 41 to 55 breaths per minute.
• Respiratory rate 6 months or older: 31 to 45 breaths per minute.
• Wheezing/crackles: Expiration only.
• Oxygen saturation on room air: 92% to 94%.
• Accessory respiratory muscle use: Mild intercostal retractions.

Score 2

• Respiratory rate younger than 6 months: 56 to 70 breaths per minute.
• Respiratory rate 6 months or older: 46 to 60 breaths per minute.
• Wheezing/crackles: Expiration and inspiration with stethoscope only.
• Oxygen saturation on room air: 90% to 91%.
• Accessory respiratory muscle use: Moderate amount of intercostal retractions.

Score 3

• Respiratory rate younger than 6 months: 71 breaths per minute or higher.
• Respiratory rate 6 months or older: 61 breaths per minute or higher.
• Wheezing/crackles: Expiration and inspiration without stethoscope.
• Oxygen saturation on room air: 89% or lower.
• Accessory respiratory muscle use: Moderate or marked intercostal retractions with head bobbing or tracheal tugging.

Modified Tal Score Severity

• Mild: score below 5.
• Moderate: score 6 to 10.
• Severe: score 11 or higher.