The Preschool Respiratory Assessment Measure (PRAM): A responsive index of acute asthma severity

• Published in: The Journal of pediatrics Vol. 137; no. 6; pp. 762 - 768
• Main Authors: Chalut, Dominic S., Ducharme, Francine M., Davis, Geoffrey M.
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.12.2000; Elsevier
• Subjects: Acute Disease; Asthma - diagnosis; Asthma - physiopathology; Biological and medical sciences; Child; Child, Preschool; Chronic obstructive pulmonary disease, asthma; Cohort Studies; Female; Humans; Investigative techniques of respiratory function; Investigative techniques, diagnostic techniques (general aspects); Male; Medical sciences; Pneumology; Predictive Value of Tests; Prospective Studies; Reproducibility of Results; Respiratory Function Tests; Severity of Illness Index; Rfo8; Performance evaluation; Pediatrics; Induced bronchodilation; Multivariate analysis; Obstruction; Respiratory tract; Emergency department; Cohort study; Respiratory distress; Obstructive pulmonary disease; Child; Human; Statistical analysis; Respiratory disease; Acute; Bronchodilator; Treatment efficiency; Exploration; Asthma; Resistance; Symptomatology; Chemotherapy; Treatment; Forced oscillation; Severity score; Technique
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1067/mpd.2000.110121

Objective: To elaborate and validate a Preschool Respiratory Assessment Measure (PRAM) that would accurately reflect the severity of airway obstruction and the response to treatment in young patients with asthma. Study design: A prospective cohort study was performed in 217 children aged 3 to 6 years who presented to a pediatric emergency department with acute asthma. Respiratory resistance measured by forced oscillation served as a gold standard. Children were randomized to either the test group, in which multivariate analyses were performed to elaborate the PRAM, or the validation group, in which the characteristics of the PRAM were tested. Results: For the test group (N = 145), the best multivariate model contained 5 variables: wheezing, air entry, contraction of scalenes, suprasternal retraction, and oxygen saturation. In the validation group (N = 72), the PRAM correlated substantially with the change in resistance (r = 0.58) but modestly with the % predicted resistance measured before (r = 0.22) and after bronchodilation (r = 0.36). A change of 3 (95% CI: 2.2, 3.0) indicated a clinically important change. Conclusions: PRAM appears to be a responsive but moderately discriminative tool for assessing acute asthma severity. This measure, designed for preschool-aged children, has been validated against a concurrent measure of lung function. (J Pediatr 2000;137:762-8)