This calculator is for general information and education. It is not medical advice and does not replace the judgment of a doctor, nurse or pharmacist who knows the full clinical picture.
Grading an asthma attack in a child
Children’s asthma attacks range from a mild wheeze to a life-threatening crisis. Spirometry is rarely possible in a distressed young child, so emergency teams use clinical scores. The Pediatric Respiratory Assessment Measure (PRAM), developed at Montreal’s Sainte-Justine hospital, has been validated for children aged 2 to 17 and is used in many emergency departments.
The five items
| Item | Points |
|---|---|
| Suprasternal retractions | absent 0, present 2 |
| Scalene muscle contraction | absent 0, present 2 |
| Air entry | normal 0, decreased at the bases 1, widespread decrease 2, absent or minimal 3 |
| Wheezing | absent 0, expiratory only 1, inspiratory and expiratory 2, audible without a stethoscope or silent chest 3 |
| Oxygen saturation in room air | 95% or more 0, 92 to 94% 1, under 92% 2 |
The total ranges from 0 to 12. A “silent chest”, with no wheezing because almost no air moves, scores the maximum for wheezing: it is a sign of severity, not improvement.
Interpretation
| PRAM | Severity |
|---|---|
| 0 to 3 | Mild |
| 4 to 7 | Moderate |
| 8 to 12 | Severe |
Example
A child with suprasternal retractions (2), no scalene contraction (0), decreased air entry at the bases (1), expiratory wheeze (1) and a saturation of 93% (1) scores 5: a moderate attack.
How it is used
Care pathways typically link the score to treatment: inhaled bronchodilators for all, oral corticosteroids for moderate and severe attacks, and repeated bronchodilators, magnesium or intensive care for severe attacks. The score is repeated after each treatment step to judge the response and decide on discharge or admission.
When to seek help urgently
Difficulty speaking or feeding, drowsiness, blue lips, exhaustion or a reliever inhaler that no longer helps are emergencies, whatever the score.