Elsevier

The Journal of Pediatrics

Volume 137, Issue 6, December 2000, Pages 762-768
The Journal of Pediatrics

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

https://doi.org/10.1067/mpd.2000.110121Get rights and content

Abstract

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)

Section snippets

METHODS

We conducted a prospective cohort study in a convenience sample of children presenting with acute asthma during active recruitment hours to the Montreal Children’s Hospital Emergency Department. The data were accrued as part of 2 successive studies,10, 13 both of which were approved by Institutional Board Review. Informed consent was obtained from parents or guardians.

Children were eligible if they (1) were aged ≤6 years, (2) met American Thoracic Society criteria for asthma,14 (3) required

RESULTS

We approached 548 children aged 3 to 6 years. Of these, 281 patients were excluded: 36 required no treatment with nebulized β2-agonists, 179 were unable to reproducibly perform the respiratory resistance technique, 31 had severe asthma that required continuous β2-agonist nebulization, 18 had a coexistent acute or chronic illness, and 17 had been enrolled previously. Eleven subjects declined participation, and 39 children had no height measurement, which precluded the interpretation of Rfo8. The

DISCUSSION

The 12-point PRAM is a responsive but modestly discriminative tool for assessing the severity of acute asthma exacerbations in children aged 3 to 6 years. With a performance similar to physicians’ appraisal of severity, this measure offers the advantage of validated criteria for interpreting the severity of airway obstruction (mild: <5, moderate: ≥5) and identifying a clinically meaningful improvement (change from baseline ≥3). This measure was validated by criterion validity against a

Acknowledgements

We are indebted to the many patients, the emergency physicians, and the research nurses (Jacques Lauzon and Francine Proulx) at the Montreal Children ’s Hospital, whose collaboration made this study possible. We thank Ms Michele Gibbon for her diligent data processing and Hong Yeng for statistical assistance.

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    • Cited by (0)

    ☆

    Supported by the Montreal Children’s Hospital-McGill University Research Institute and the Medical Research Council of Canada.

    ☆☆

    Reprint requests: Francine Ducharme, MD, Departments of Pediatrics and of Epidemiology & Biostatistics, The Montreal Children’s Hospital, 2300 Tupper St, Room C538E, Montreal, Quebec, Canada, H3H 1P3.

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