The Pediatric Respiratory Assessment Measure: a valid clinical score for assessing acute asthma severity from toddlers to teenagers.

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 alpha = 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.

[1]  Lewis E. Kazis,et al.  Effect Sizes for Interpreting Changes in Health Status , 1989, Medical care.

[2]  R. Edwards,et al.  Repeatability of physical signs in airways obstruction , 1969, Thorax.

[3]  G. Guyatt,et al.  A methodologic framework for health status measures: clarity or oversimplification? , 1992, Journal of clinical epidemiology.

[4]  L. Cronbach.  Coefficient alpha and the internal structure of tests , 1951 .

[5]  F. Ducharme,et al.  The Preschool Respiratory Assessment Measure (PRAM): a responsive index of acute asthma severity. , 2000, The Journal of pediatrics.

[6]  F. Simons,et al.  The pulmonary index. Assessment of a clinical score for asthma. , 1984, American journal of diseases of children.

[7]  M. Gorelick,et al.  Short-term outcomes after acute treatment of pediatric asthma. , 2001, Pediatrics.

[8]  B. Rowe,et al.  Early emergency department treatment of acute asthma with systemic corticosteroids. , 2001, The Cochrane database of systematic reviews.

[9]  Johannes B Reitsma,et al.  Evidence of bias and variation in diagnostic accuracy studies , 2006, Canadian Medical Association Journal.

[10]  Asthma severity scores for preschoolers displayed weaknesses in reliability, validity, and responsiveness. , 2004, Journal of clinical epidemiology.

[11]  J. Baty,et al.  Validation of the pulmonary score: an asthma severity score for children. , 2002, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[12]  Derek Stephens,et al.  Oxygen saturation as a predictor of prolonged, frequent bronchodilator therapy in children with acute asthma. , 2004, The Journal of pediatrics.

[13]  Colin Powell,et al.  Is severity assessment after one hour of treatment better for predicting the need for admission in acute asthma? , 2004, Respiratory medicine.

[14]  D. Jarvis,et al.  Accident and emergency departments are still failing to assess asthma severity , 2003, Emergency medicine journal : EMJ.

[15]  F. Ducharme,et al.  Should inhaled anticholinergics be added to β2 agonists for treating acute childhood and adolescent asthma? A systematic review , 1998, BMJ.

[16]  W. Mower,et al.  Pulse oximetry as a fifth pediatric vital sign. , 1997, Pediatrics.

[17]  F. Ducharme,et al.  Measurement of respiratory resistance in the emergency department: feasibility in young children with acute asthma. , 1997, Chest.

[18]  M. Cabana,et al.  Documentation of Asthma Severity in Pediatric Outpatient Clinics , 2003, Clinical pediatrics.

[19]  L. Bouter,et al.  Clinical scores for acute asthma in pre-school children. A review of the literature. , 1994, Journal of clinical epidemiology.

[20]  G. Canny,et al.  Hospitalization patterns in severe acute asthma in children , 1997, Pediatric pulmonology.

[21]  B. Rowe,et al.  Holding chambers versus nebulisers for beta-agonist treatment of acute asthma. , 2003, The Cochrane database of systematic reviews.

[22]  T. Schultz,et al.  Difficulty in Obtaining Peak Expiratory Flow Measurements in Children With Acute Asthma , 2004, Pediatric emergency care.

[23]  P. L. Le Souëf,et al.  Evaluation of SaO2 as a predictor of outcome in 280 children presenting with acute asthma. , 1994, Annals of emergency medicine.

[24]  D. Gladman,et al.  Methods for assessing responsiveness: a critical review and recommendations. , 2000, Journal of clinical epidemiology.

[25]  Jacob Cohen,et al.  Weighted kappa: Nominal scale agreement provision for scaled disagreement or partial credit. , 1968 .

[26]  R. Pauwels,et al.  GLOBAL STRATEGY FOR ASTHMA MANAGEMENT AND PREVENTION , 1996 .

[27]  C. Elliott.  Acute asthma: Observations regarding the management of a pediatric emergency room , 1990 .

[28]  G. Guyatt,et al.  Measuring change over time: assessing the usefulness of evaluative instruments. , 1987, Journal of chronic diseases.

[29]  T. Schultz,et al.  Performance of a novel clinical score, the Pediatric Asthma Severity Score (PASS), in the evaluation of acute asthma. , 2004, Academic emergency medicine : official journal of the Society for Academic Emergency Medicine.

[30]  D. van der Windt.  Promises and pitfalls in the evaluation of pediatric asthma scores. , 2000, The Journal of pediatrics.

[31]  William M. K. Trochim,et al.  Research methods knowledge base , 2001 .

[32]  P. Lesouëf,et al.  Predictive value of oxygen saturation in emergency evaluation of asthmatic children. , 1988, BMJ.