Pediatric_Respiratory_Assessment_Measure_PRAM_for_Asthma_Exacerbation_Severity_guideline v.1
The Pediatric Respiratory Assessment Measure (PRAM) provides an objective assessment of asthma exacerbation severity and can predict likelihood of admission or extended ED stay. FORMULA Addition of selected points. (If asymmetry, use the most severely affected lung field) - O2 saturation: ≥95%: 0p, 92-94%: 1p, <92%: 2p - Suprasternal retractions present: No: 0p, Yes: 2p - Scalene muscle contractions present: No: 0p, Yes: 2p - Air entry: Normal: 0p, Decreased at the base: 1p, Decreased at the apex and the base: 2p, Minimal or absent: 3p - Wheezing: Absent: 0p, Expiratory only: 1p, Inspiratory (± expiratory): 2p, Audible without stethoscope or silent chest (minimal or no air entry): 3p Score interpretation: Score 0-3: Asthma Severity is Mild Score 4-7: Asthma Severity is Moderate Score 8-12: Asthma Severity is Severe
This score can help decide which patients need admission, especially when providers disagree or the patient may be “borderline” for needing admission.
The PRAM has been used in pediatric patients 3-17 years old with asthma exacerbations and works best to evaluate improvement of symptoms pre- and post-treatment. The PRAM does use clinical findings like retractions (which can play a direct role in the decision to admit), and it may over-estimate the score's independent value.
The PRAM is not typically used in severe asthma exacerbations, as these obviously require very aggressive, intensive treatment (including admission).
Chalut DS, Ducharme FM, Davis GM. The Preschool Respiratory Assessment Measure (PRAM): a responsive index of acute asthma severity. The Journal of pediatrics. 2000 Dec 1;137(6):762-8. Ducharme FM, Chalut D, Plotnick L, Savdie C, Kudirka D, Zhang X, Meng L, McGillivray D. The Pediatric Respiratory Assessment Measure: a valid clinical score for assessing acute asthma severity from toddlers to teenagers. The Journal of pediatrics. 2008 Apr 1;152(4):476-80.
OBSERVATION.pediatric_respiratory_assessment_measure_pram_for_asthma_exacerbation_severity.v0, EVALUATION.pediatric_respiratory_assessment_measure_pram_for_asthma_exacerbation_severity.v0
