What does PRAM measure?

PRAM measures the severity of an acute asthma exacerbation in children. It is not a diagnostic probability score.

What age range was PRAM validated for?

The 2008 prospective validation study assessed children aged 2–17 years with acute asthma.

How is PRAM interpreted?

A total of 0–3 is mild, 4–7 moderate, and 8–12 severe. Clinical danger signs can override the numerical category.

Can a quiet chest mean the attack is improving?

No. Minimal air entry or a silent chest can indicate severe airflow obstruction and scores maximum points in the relevant PRAM components.

Does PRAM replace medical assessment?

No. Altered consciousness, cyanosis, exhaustion, or decreasing respiratory effort requires immediate emergency assessment regardless of score.

PRAM Asthma Severity Score Calculator

Score oxygen saturation, retractions, scalene contraction, air entry, and wheezing to calculate the 0–12 PRAM acute asthma severity score.

PRAM Components

Select one observed value for every component. Assessment is intended for trained healthcare professionals.

Room-air oxygen saturation

Suprasternal retraction

Scalene muscle contraction

Air entry

Wheezing

PRAM Total

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out of 12

Complete all five observations.

Safety: altered consciousness, agitation, cyanosis, exhaustion, or decreasing respiratory effort can indicate impending respiratory failure regardless of PRAM. Seek emergency care immediately.

Method: Ducharme et al., Journal of Pediatrics (2008), validated in ages 2–17. This calculator supports arithmetic only and does not prescribe treatment.

Summary

The Pediatric Respiratory Assessment Measure (PRAM) is a validated 12-point clinical score for assessing acute asthma severity and response to treatment in children aged 2–17 years. It combines room-air oxygen saturation, suprasternal retraction, scalene muscle contraction, air entry, and wheezing. PRAM measures current exacerbation severity; it does not diagnose asthma or replace urgent clinical assessment.

How it works

Record oxygen saturation on room air after the value stabilizes.
Assess suprasternal retraction and scalene muscle contraction.
Grade air entry in the most severely affected lung field.
Grade wheezing across the affected auscultation zones.
The five component scores are summed to a total from 0 to 12.
Interpret 0–3 as mild, 4–7 as moderate, and 8–12 as severe acute asthma.

Use cases

Standardize pediatric acute asthma severity assessment at triage.
Document change after bronchodilator treatment.
Teach the five PRAM components and their point values.
Double-check bedside score arithmetic.

Frequently Asked Questions

Last updated: 2026-09-10 · Reviewed by Nham Vu