🧒 Pediatric Respiratory Assessment Measure (PRAM)
Grade pediatric acute asthma severity with the PRAM score.
Clinical takeaway
Air entry and wheezing scored on the worst side.
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When to use
Assess severity and treatment response in childhood asthma exacerbations.
How it works
Suprasternal retraction, scalene contraction, air entry, wheezing and SpO₂, total 0–12. 0–3 mild, 4–7 moderate, 8–12 severe.
Key points
- Air entry and wheezing scored on the worst side.
- Applicable ages 1–17 years.
- A change ≥ 3 is clinically meaningful.
References
Decision support for licensed clinicians only; not a substitute for clinical judgement, diagnosis or local protocols.
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
Frequently asked 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）