The Pediatric Respiratory Assessment Measure: A Valid Clinical Score for Assessing Acute Asthma Severity from Toddlers to Teenagers

Ducharme, Francine M.; Chalut, Dominic; Plotnick, Laurie; Savdie, Cheryl; Kudirka, Denise; Zhang, Xun; Meng, Linyan; McGillivray, David

doi:10.1016/j.jpeds.2007.08.034

« Previous Next »The Journal of Pediatrics
Volume 152, Issue 4 , Pages 476-480.e1, April 2008

The Pediatric Respiratory Assessment Measure: A Valid Clinical Score for Assessing Acute Asthma Severity from Toddlers to Teenagers

Francine M. Ducharme, MD, MSc
- Clinical Research Group on Childhood Asthma, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
- Reprint requests: Dr Francine Ducharme, Department of Pediatrics, Montreal Children’s Hospital of McGill University Health Centre, 2300 Tupper Street, Montréal, Québec, Canada, H3H 1P3.
Dominic Chalut, MD
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital of McGill University Health Centre, Montreal, Quebec, Canada
Laurie Plotnick, MD
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital of McGill University Health Centre, Montreal, Quebec, Canada
Cheryl Savdie, MSc
- Clinical Research Group on Childhood Asthma, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
Denise Kudirka, RN
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital of McGill University Health Centre, Montreal, Quebec, Canada
Xun Zhang, PhD
- Service of Biostatistics, Montreal Children’s Hospital Research Institute, McGill University Health Centre, Montreal, Quebec, Canada.
Linyan Meng, MSc
- Clinical Research Group on Childhood Asthma, Department of Pediatrics, McGill University Health Centre, Montreal, Quebec, Canada
David McGillivray, MD
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital of McGill University Health Centre, Montreal, Quebec, Canada

Received 15 March 2007; received in revised form 4 June 2007; accepted 17 August 2007. published online 01 November 2007.

Objective

To determine the performance characteristics of the Preschool Respiratory Assessment Measure (PRAM) in preschool and school-aged children with acute asthma.

Study design

In a prospective cohort study, we examined the validity, responsiveness, and reliability of the PRAM in children aged 2 to 17 years with acute asthma. The study involved more than 100 nurses and physicians who recorded the PRAM on triage, after initial bronchodilation, and at disposition. Predictive validity and responsiveness were examined using disposition as outcome.

Results

The PRAM was recorded in 81% (n = 782) of patients at triage. The PRAM at triage and after initial bronchodilation showed a strong association with admission (r = 0.4 and 0.5, respectively; P < .0001), thus supporting its ability to distinguish across severity levels. The responsiveness coefficient of 0.7 indicated good ability to identify change after bronchodilation. The PRAM showed good internal consistency (Cronbach α = 0.71) and inter-rater reliability (r = 0.78) for all patients and across all age groups.

Conclusions

Good performance characteristics were observed in all age groups, making the PRAM an attractive score for assessing asthma severity and response to treatment.

Abbreviations: PASS, Pediatric Asthma Severity Score, PRAM, Preschool Respiratory Assessment Measure