PRAM Score for Pediatric Asthma Exacerbation Severity

Assess asthma severity in pediatric patients


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.


Chalut DS, Ducharme FM, Davis GM.

Journal of Pediatrics 2000, 137 (6): 762-8

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1. O2 Saturation %

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