Pediatric Respiratory Assessment Measure (PRAM) — free guideline decision tool
Grade pediatric acute asthma severity with the PRAM score.
Open guideline tool →Guideline-based
Implements the decision logic from published clinical guidelines.
Runs in your browser
No installation. Enter the patient's values and get a guideline recommendation instantly.
Data stays local
Nothing is uploaded. Results are for licensed clinicians only.
Worked calculation
The values below come from this tool's own example placeholders and are computed server-side with the formula shown on this page, so the arithmetic can be checked quickly. It demonstrates how to substitute values only — it is not clinical advice and not a real case.
| Suprasternal retraction | Absent (0) |
|---|---|
| Scalene muscle contraction | Absent (0) |
| Air entry (worst side) | Normal (0) |
| Wheezing (worst side) | Absent (0) |
| Oxygen saturation | > 95% (0) |
→PRAM0/12
- Severity：0 → Mild (0–3 mild, 4–7 moderate, 8–12 severe)
- Action：Mild: inhaled salbutamol, oral steroids as appropriate; observe and reassess, often manageable as outpatient
- Note：Air entry and wheezing scored on the worst side. Applicable ages 1–17 y. A change ≥ 3 is clinically meaningful
| Suprasternal retraction | Present (2) |
|---|---|
| Scalene muscle contraction | Present (2) |
| Air entry (worst side) | Absent/minimal (3) |
| Wheezing (worst side) | Audible without stethoscope or silent chest/minimal air entry (3) |
| Oxygen saturation | < 92% (2) |
→PRAM12/12
- Severity：12 → Severe (0–3 mild, 4–7 moderate, 8–12 severe)
- Action：Severe: continuous/frequent nebulized salbutamol + ipratropium, early systemic corticosteroids, oxygen to maintain SpO₂, consider magnesium sulfate; monitor and assess for escalation (admission/PICU)
- Note：Air entry and wheezing scored on the worst side. Applicable ages 1–17 y. A change ≥ 3 is clinically meaningful
Common questions
What is Pediatric Respiratory Assessment Measure (PRAM)?
Grade pediatric acute asthma severity with the PRAM score.
How is Pediatric Respiratory Assessment Measure (PRAM) calculated? What is the core formula?
Suprasternal retraction, scalene contraction, air entry, wheezing and SpO₂, total 0–12. 0–3 mild, 4–7 moderate, 8–12 severe.
When is Pediatric Respiratory Assessment Measure (PRAM) used?
Assess severity and treatment response in childhood asthma exacerbations.
What are the key clinical points for Pediatric Respiratory Assessment Measure (PRAM)?
Air entry and wheezing scored on the worst side. Applicable ages 1–17 years. A change ≥ 3 is clinically meaningful.
What are the limits and cautions when using Pediatric Respiratory Assessment Measure (PRAM)?
For licensed clinicians and clinical researchers. Interpret results with history, investigations and local protocols; not a diagnosis or prescription, and not a substitute for multidisciplinary decision-making or local guidelines.
How is Pediatric Respiratory Assessment Measure (PRAM) calculated in practice? Can you show a worked example?
Inputs: Suprasternal retraction Absent (0), Scalene muscle contraction Absent (0), Air entry (worst side) Normal (0), Wheezing (worst side) Absent (0), Oxygen saturation > 95% (0) → Result: PRAM 0 /12（Severity: 0 → Mild (0–3 mild, 4–7 moderate, 8–12 severe), Action: Mild: inhaled salbutamol, oral steroids as appropriate; observe and reassess, often manageable as outpatient, Note: Air entry and wheezing scored on the worst side. Applicable ages 1–17 y. A change ≥ 3 is clinically meaningful） Inputs: Suprasternal retraction Present (2), Scalene muscle contraction Present (2), Air entry (worst side) Absent/minimal (3), Wheezing (worst side) Audible without stethoscope or silent chest/minimal air entry (3), Oxygen saturation < 92% (2) → Result: PRAM 12 /12（Severity: 12 → Severe (0–3 mild, 4–7 moderate, 8–12 severe), Action: Severe: continuous/frequent nebulized salbutamol + ipratropium, early systemic corticosteroids, oxygen to maintain SpO₂, consider magnesium sulfate; monitor and assess for escalation (admission/PICU), Note: Air entry and wheezing scored on the worst side. Applicable ages 1–17 y. A change ≥ 3 is clinically meaningful）
Run Pediatric Respiratory Assessment Measure (PRAM) now
Grade pediatric acute asthma severity with the PRAM score.
Open guideline tool →For licensed clinicians. Not a substitute for clinical judgement.
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