Calculators & Tools

PRAM Score

Preschool Respiratory Assessment Measure - asthma exacerbation severity.

1 What is the PRAM Score?

The PRAM Score is a respiratory scoring tool used in paediatric practice. Preschool Respiratory Assessment Measure - asthma exacerbation severity. It scores 5 criteria and interprets the total across 3 bands, so the number always arrives with the severity it implies rather than on its own. In PediAid each criterion is shown as a labelled option with the weight it carries, so the total can be checked rather than taken on trust.

2 When to use it

  • Grading severity at the bedside in respiratory
  • Recording an objective severity band in the case notes
  • Deciding when a total crosses the threshold for escalation
  • Re-scoring to track whether a child is improving or deteriorating
  • Checking the exact criteria of a score used infrequently

3 Formula & method

The score sums 5 criteria: Suprasternal retractions; Scalene muscle contraction; Air entry; Wheezing; Oxygen saturation on room air. Totals are then banded: any score - Mild: pRAM 0-3 - mild exacerbation. Inhaled short-acting beta-agonist; usually dischargeable after response; 4 points or more - Moderate: pRAM 4-7 - moderate exacerbation. Frequent bronchodilators plus systemic corticosteroid; observe for response; 8 points or more - Severe: pRAM 8-12 - severe exacerbation. Continuous bronchodilators, systemic steroid, consider magnesium sulphate, oxygen and admission/HDU.
  • Total range 0-12. Validated for children aged roughly 2-17 years.
  • Source: Chalut DS, Ducharme FM, Davis GM. The Preschool Respiratory Assessment Measure (PRAM). J Pediatr 2000;137:762-8.

4 Frequently asked questions

How many criteria does the PRAM Score use?

5. They are Suprasternal retractions; Scalene muscle contraction; Air entry; Wheezing; Oxygen saturation on room air.

What do the bands of the PRAM Score mean?

The total is interpreted as: any score - Mild: pRAM 0-3 - mild exacerbation. Inhaled short-acting beta-agonist; usually dischargeable after response; 4 points or more - Moderate: pRAM 4-7 - moderate exacerbation. Frequent bronchodilators plus systemic corticosteroid; observe for response; 8 points or more - Severe: pRAM 8-12 - severe exacerbation. Continuous bronchodilators, systemic steroid, consider magnesium sulphate, oxygen and admission/HDU.

Does the score replace clinical judgement?

No. It is a structured way to record and communicate severity. A clinician concerned about a child should act on that concern regardless of the total.

Where does this score come from?

Total range 0-12. Validated for children aged roughly 2-17 years.

Does it work offline?

Yes. Score definitions are bundled with the PediAid app, so the score computes without a connection.

For qualified clinicians. This page and the PediAid app are a clinical aid only. Calculations and reference data must be verified against the patient's clinical context, the source guideline and your local protocols before any treatment decision is made.