Modified Pediatric Respiratory Assessment Measure (PRAM): Inpatient asthma clinical score

Signs	0	1	2	3
Suprasternal indrawing	Absent		Present
Scalene retractions	Absent		Present
Wheezing	Absent	Expiratory only	Inspiratory and expiratory	Audible without stethoscope/silent chest
Air entry	Normal	Decreased at bases	Widespread decrease	Absent/minimal

Phase change criteria – Score of <3 at routine assessment or clinician order on reassessment in Phase I or Phase II (all phase changes require verbal or written clinician order).

For beta₂ agonist assessment – If score ≥3 give beta₂ agonist, if <3 no beta₂ agonist.

For any assessment score ≥6 – Give beta₂ agonist and notify clinician. If in Phase II or Phase III, move back to previous phase. If in Phase I, consider further investigations, reassess therapy (beta₂ agonist frequency, IV, oxygen, etc) and consider ICU consultation if not responding to treatment.

ICU: intensive care unit; IV: intravenous.

Reproduced from: Chalut DS, Ducharme FM, Davis GM. The Preschool Respiratory Assessment Measure (PRAM): A responsive index of acute asthma severity. J Pediatr 2000; 137:762. Original figure modified for this publication. Table used with the permission of Elsevier Inc. All rights reserved.

Graphic 91732 Version 4.0

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Modified Pediatric Respiratory Assessment Measure (PRAM): Inpatient asthma clinical score