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PRAM Score



Key results:
Based on low quality evidence, a strong recommendation is made to use the PRAM score to assess asthma severity in the ED/UCC for a pediatric patient with an acute asthma exacerbation. The expansion of the PRAM from a score to be used in pre-school patients to the overall pediatric population is clearly described (Ducharme et al., 2008). Subsequent studies have identified a high PRAM score as a strong predictor of hospital admission (Alnaji, Zemek, Barrowman, & Plint, 2014; Gouin et al., 2010) and extended ED stays (Alnaji et al., 2014; Gouin et al., 2010).

For additional information click here for the Asthma Scores Critically Appraised Topic (CAT)


Alnaji, F., Zemek, R., Barrowman, N., & Plint, A. (2014). PRAM score as predictor of pediatric asthma hospitalization. Acad Emerg Med, 21(8), 872-878. doi:10.1111/acem.12422

Ducharme, F. M., Chalut, D., Plotnick, L., Savdie, C., Kudirka, D., Zhang, X., . . . McGillivray, D. (2008). The Pediatric Respiratory Assessment Measure: a valid clinical score for assessing acute asthma severity from toddlers to teenagers. J Pediatr, 152(4), 476-480, 480 e471. doi:10.1016/j.jpeds.2007.08.034 

Gouin, S., Robidas, I., Gravel, J., Guimont, C., Chalut, D., & Amre, D. (2010). Prospective evaluation of two clinical scores for acute asthma in children 18 months to 7 years of age. Acad Emerg Med, 17(6), 598-603. doi:10.1111/j.1553-2712.2010.00775.x 

These guidelines do not establish a standard of care to be followed in every case. It is recognized that each case is different and those individuals involved in providing health care are expected to use their judgment in determining what is in the best interests of the patient based on the circumstances existing at the time. It is impossible to anticipate all possible situations that may exist and to prepare guidelines for each. Accordingly these guidelines should guide care with the understanding that departures from them may be required at times.