Chalut et al developed the Preschool Respiratory Assessment Measure (PRAM) to evaluate asthma severity. This was extended to all pediatric patients and renamed the Pediatric Respiratory Assessment Measure. The authors are from McGill University and Montreal Children's Hospital.
Patient selection: pediatric patient with asthma
Parameters:
(1) suprasternal retractions
(2) scalene contractions
(3) air entry (if left and right sides are asymmetrical, use worse side)
(4) wheezing (if left and right sides are asymmetrical, use worse side)
(5) oxygen saturation
|
Parameter
|
Finding
|
Points
|
|
suprasternal retraction
|
absent
|
0
|
|
|
present
|
2
|
|
scalene retraction
|
absent
|
0
|
|
|
present
|
2
|
|
air entry
|
normal
|
0
|
|
|
decreased at lung bases
|
1
|
|
|
widespread decrease
|
2
|
|
|
absent or minimal
|
3
|
|
wheezing
|
none
|
0
|
|
|
expiration only
|
1
|
|
|
inspiration and expiration
|
2
|
|
|
audible without stethoscope OR silent chest
|
3
|
|
oxygen saturation
|
>= 95%
|
0
|
|
|
92 to 94%
|
1
|
|
|
<= 91%
|
2
|
total score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum score: 0
• maximum score: 12
• The higher the score the more severe the asthma.
• With effective therapy the PRAM should decrease, while it will increase with disease progression.
Performance:
• Duscharme et al demonstrated that the PRAM was able to distinguish between levels of disease severity and response to therapy with good internal consistency and inter-rater reliability.
• Arnold et al determined that PRAM was more sensitive than spirometry for changes in acute asthma severity.
