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The PRAM score was developed as a bedside clinical tool to assist clinicians at grading acute asthma severity in the pediatric population.
The initial prospective cohort study (Chalut et al. 2000) enrolled 217 children ages 3-6 presenting to the pediatric emergency department and compared multiple clinical variables against a gold standard in grading asthma severity. They isolated 5 examination parameters with the highest correlation to the gold standard test and created the PRAM score as the most useful multi-variate analysis.
The PRAM score was subsequently validated (Ducharme et al. 2008) for children aged 2-17 presenting to the pediatric emergency department, demonstrating good internal consistency and inter-rater reliability for all patients across this age range. The validation study showed a strong correlation between PRAM score and admission rates suggesting its ability to categorize severity.
Variable & Associated Points
Variables considered include O2 Saturation %, Suprasternal notch retractions, Scalene muscle contractions present, Air entry (using most severely affected lung), Wheezing (using most severely affected lung).
Mild Asthma = Score 0 - 3
Moderate Asthma = Score 4 - 7
Severe Asthma = Score 7 - 12.
References Contributed By:
Chalut DS, Ducharme FM, Davis GM.
The Preschool Respiratory Assessment Measure (PRAM): A responsive index of acute asthma severity.
J Pediatr. 2000; 137:762-768.
Ducharme FM et al.
The Pediatric Respiratory Assessment Measure: a valid clinical score for assessing acute asthma severity from toddlers to teenagers.
J Pediatr 2008; 152(4): 476-80
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