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PRAM score as predictor of pediatric asthma hospitalization

Fuad Alnaji1, Roger Zemek, Nick Barrowman

  • 1The Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa.

Academic Emergency Medicine : Official Journal of the Society for Academic Emergency Medicine
|September 2, 2014
PubMed

Insights

The 3-hour Pediatric Respiratory Assessment Measure (PRAM) score is a strong predictor of hospitalization for pediatric asthma exacerbations. This score aids clinicians in deciding on admission or further treatment to reduce hospital stays.

Area of Science:

  • Pediatric Emergency Medicine
  • Respiratory Medicine
  • Clinical Decision Support

Background:

  • Pediatric asthma exacerbations presenting to the emergency department (ED) require accurate severity assessment for timely management.
  • The Pediatric Respiratory Assessment Measure (PRAM) is used to quantify asthma severity in children.
  • Intensive asthma therapy, including bronchodilators and oral steroids, is often initiated in the ED.

Purpose of the Study:

  • To evaluate the association between PRAM scores and the likelihood of hospital admission in pediatric patients with moderate-to-severe asthma exacerbations receiving intensive therapy.
  • To determine if PRAM scores obtained at different time points predict inpatient hospitalization.

Main Methods:

  • Secondary analysis of a prospective study involving pediatric patients (2-17 years) with moderate-to-severe asthma (PRAM ≥ 4).
  • Patients received nurse-initiated intensive asthma therapy (bronchodilator and oral steroids) upon triage.
  • PRAM scores were recorded hourly; logistic regression and Area Under the Curve (AUC) analysis were used to predict hospitalization.

Main Results:

  • A total of 297 patients were analyzed, with an 11.4% admission rate among those receiving intensive therapy.
  • The 3-hour PRAM score demonstrated significantly improved prediction of admission (AUC = 0.85) compared to the triage PRAM score (p = 0.04).

Conclusions:

  • The PRAM score measured 3 hours after presentation is the most effective predictor of hospitalization for pediatric asthma exacerbations.
  • These findings can inform clinical decisions in the ED to optimize patient management and potentially reduce hospital admissions.
Abstract

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