The Pediatric Respiratory Assessment Measure (PRAM) is a 12-point bedside score for acute asthma exacerbation severity in children, based on oxygen saturation, suprasternal retractions, scalene muscle contraction, air entry and wheeze.

Derivation. The original Preschool Respiratory Assessment Measure was derived in a prospective cohort of 217 children aged 3–6 years with acute asthma presenting to a paediatric emergency department, using forced oscillation measurements of airway resistance as the reference standard and selecting these five variables as the most informative combination.

Validation and age range. A subsequent prospective cohort study in children aged 2–17 years with acute asthma presenting to a paediatric emergency department showed that PRAM scores recorded at triage and after initial bronchodilation correlated with need for hospital admission and change in clinical status, with good internal consistency and inter-rater reliability across age groups.

Risk bands and implementation. Commonly used bands are 0–3 (mild), 4–7 (moderate) and 8–12 (severe) exacerbation. PRAM-based severity assessment has been incorporated into paediatric emergency and inpatient asthma pathways, and implementation of severity-specific guidelines using PRAM has been associated with reduced paediatric asthma hospitalisation rates in quality-improvement studies.

Use PRAM in children with known or suspected asthma or recurrent wheeze presenting with an acute exacerbation, typically from about 2 to 17 years of age, in emergency or acute care settings. It is less well validated in infants, in primary care, or for other causes of respiratory distress such as bronchiolitis or chronic lung disease, and results should be interpreted alongside the overall clinical picture and local paediatric asthma guidelines.

Pediatric Respiratory Assessment Measure (PRAM) for Asthma Exacerbation Severity