Original articleThe Pediatric Respiratory Assessment Measure: A Valid Clinical Score for Assessing Acute Asthma Severity from Toddlers to Teenagers
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
References (32)
- et al.
Measurement of respiratory resistance in the emergency department: feasibility in young children with acute asthma
Chest
(1997) - et al.
Clinical scores for acute asthma in pre-school childrenA review of the literature
J Clin Epidemiol
(1994) Promises and pitfalls in the evaluation of pediatric asthma scores
J Pediatr
(2000)- et al.
Asthma severity scores for preschoolers displayed weaknesses in reliability, validity, and responsiveness
J Clin Epidemiol
(2004) - et al.
The preschool respiratory assessment measure (PRAM): A responsive index of acute asthma severity
J Pediatr
(2000) - et al.
A methodologic framework for health status measures: Clarity or oversimplification?
J Clin Epidemiol
(1992) - et al.
Measuring change over time: Assessing the usefulness of evaluative instruments
J Chron Dis
(1987) - et al.
Methods for assessing responsiveness: A critical review and recommendations
J Clin Epidemiol
(2000) - et al.
Evaluation of Sa02 as a predictor of outcome in 280 children presenting with acute asthma
Ann Emerg Med
(1994) - et al.
Oxygen saturation as a predictor of prolonged, frequent bronchodilator therapy in children with acute asthma
J Pediatr
(2004)
Is severity assessment after one hour of treatment better for predicting the need for admission in acute asthma?
Respir Med
Global strategy for asthma management and prevention NIH publication no 02-3659
Short-term outcomes after acute treatment of pediatric asthma
Pediatr
Performance of a novel clinical score, the Pediatric Asthma Severity Score (PASS), in the evaluation of acute asthma
Acad Emerg Med
Acute asthma: observations regarding the management of a pediatric emergency room
Pediatrics
The Pulmonary Index: Assessment of a Clinical Score for Asthma
Am J Dis Child
Cited by (164)
Defining Treatment Response for Clinical Trials of Pediatric Acute Asthma
2023, Journal of Allergy and Clinical Immunology: In PracticePredicting Severe Asthma Exacerbations in Children: Blueprint for Today and Tomorrow
2021, Journal of Allergy and Clinical Immunology: In PracticePredicting hospitalization of pediatric asthma patients in emergency departments using machine learning
2021, International Journal of Medical InformaticsThe Saudi initiative for asthma – 2024 update: Guidelines for the diagnosis and management of asthma in adults and children
2024, Annals of Thoracic Medicine
Supported by a grant of the Research Institute of the McGill University Health Centre.