Interpretation
| Result | Meaning |
|---|---|
| 0–3 | Mild |
| 4–7 | Moderate |
| 8–12 | Severe |
Formula
Suprasternal retraction 0/2 · scalene contraction 0/2 · air entry normal 0 / decreased at bases 1 / widespread 2 / absent-minimal 3 · wheeze absent 0 / expiratory 1 / inspiratory ± expiratory 2 / audible or silent chest 3 · SpO₂ ≥95% 0 / 92–94% 1 / <92% 2 (room air)
Clinical pearls
- Score SpO₂ on room air; with asymmetric findings, score the most affected lung field.
- A change of 3 points reflects a clinically important change in airway obstruction.
- Originally derived in 3–6 year olds (Chalut 2000) and later validated from toddlers to teenagers (Ducharme 2008), which also set the mild/moderate/severe bands.
Examples
pram score 4 yo suprasternal retractions, widespread decreased air entry, inspiratory wheeze, sat 91pram expiratory wheeze only, normal air entry, sats 96pediatric asthma score: scalene contraction, decreased at bases, expiratory wheeze, spo2 93%
FAQ
What is a severe PRAM score?
8 to 12 points; 4–7 is moderate and 0–3 mild.
What is the PRAM score used for?
Grading pediatric asthma exacerbation severity at triage and tracking response to bronchodilators and steroids.
Evidence
- Chalut DS, Ducharme FM, Davis GM. The Preschool Respiratory Assessment Measure (PRAM): a responsive index of acute asthma severity. J Pediatr 2000;137:762–8.
- Ducharme FM et al. The Pediatric Respiratory Assessment Measure: a valid clinical score for assessing acute asthma severity from toddlers to teenagers. J Pediatr 2008;152:476–80.