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


METHODS
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.
Chalut
D S
DS
Department of Pediatrics, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec,Canada.
Ducharme
F M
FM
Davis
G M
GM
D000208:Acute Disease; D001249:Asthma / Q000175:diagnosis* / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012129:Respiratory Function Tests; D012720:Severity of Illness Index