Preschool Respiratory Assessment Measure (PRAM) score

What it is

The Preschool Respiratory Assessment Measure, or PRAM, is the pediatric respiratory assessment measure scoring table. It gives the severity of an acute asthma exacerbation in a child, and it runs to a max. of 12.

How it is diagnosed

Five things are given a score.

• O2 saturation: 95% scores 0, 92-94% scores 1, and below 92% scores 2.
• Suprasternal retration: absent scores 0, present scores 2.
• Scalene muscle contraction: absent scores 0, present scores 2.
• Air entry: normal scores 0, reduced at the base scores 1, reduced at the apex and the base scores 2, and minimal or absent scores 3.
• Wheezing: absent scores 0, expiratory only scores 1, inspiratory with or without expiratory scores 2, and audible without stethoscope or a silent chest with minimal or no air entry scores 3.

A PRAM score of 0-3 is mild, 4-7 is moderate, and 8-12 is severe.

In case of asymmetry the worse side is taken. For air entry, the most severely affected apex-base lung field, right or left, anterior or posterior, will determine the rating of the criterion. For wheezing, the two most severely affected zones, no matter their location, will determine the rating.