Elsevier

The Journal of Pediatrics

Volume 152, Issue 4, April 2008, Pages 476-480.e1
The Journal of Pediatrics

Original article
The Pediatric Respiratory Assessment Measure: A Valid Clinical Score for Assessing Acute Asthma Severity from Toddlers to Teenagers

https://doi.org/10.1016/j.jpeds.2007.08.034Get rights and content

Objective

To determine the performance characteristics of the Preschool Respiratory Assessment Measure (PRAM) in preschool and school-aged children with acute asthma.

Study design

In a prospective cohort study, we examined the validity, responsiveness, and reliability of the PRAM in children aged 2 to 17 years with acute asthma. The study involved more than 100 nurses and physicians who recorded the PRAM on triage, after initial bronchodilation, and at disposition. Predictive validity and responsiveness were examined using disposition as outcome.

Results

The PRAM was recorded in 81% (n = 782) of patients at triage. The PRAM at triage and after initial bronchodilation showed a strong association with admission (r = 0.4 and 0.5, respectively; P < .0001), thus supporting its ability to distinguish across severity levels. The responsiveness coefficient of 0.7 indicated good ability to identify change after bronchodilation. The PRAM showed good internal consistency (Cronbach α = 0.71) and inter-rater reliability (r = 0.78) for all patients and across all age groups.

Conclusions

Good performance characteristics were observed in all age groups, making the PRAM an attractive score for assessing asthma severity and response to treatment.

Section snippets

Methods

In the spring of 2003, we introduced the PRAM as the standard assessment tool for all children aged 2 years and above presenting with acute asthma to our pediatric emergency department. In the fall of 2003, we introduced a clinical care pathway based on the PRAM and examined the impact of these interventions on guideline adherence and admission rate. Nested in this quality control initiative, we examined the feasibility, validity, and responsiveness to change of the PRAM in a prospective

Results

Of the 1039 visits made during the study period, 75 were repeat visits. Of the 964 unique patients, the PRAM was recorded at triage in 782 (81%) children; their median age was 5.8 (interquartile range, 3.5 to 9.6) years, and 63% were male. A similar proportion of preschool (20%) and school-aged (18%) children had no recorded PRAM value. They were similar in age and sex distribution as those with a recorded PRAM but required significantly less albuterol (69% vs 39% requiring ≤2 treatments, P <

Discussion

In the real-life setting of a busy pediatric emergency department, the PRAM has good validity, responsiveness to change and inter-rater reliability, not only in preschool aged children in whom it was developed but also in school-aged children and adolescents. These findings were derived from a large number of children treated by more than 100 nurses and physicians, suggesting good generalizability to similar clinical settings. The performance characteristics were stable across the entire

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    Supported by a grant of the Research Institute of the McGill University Health Centre.

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