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Pediatric respiratory assessment measure (PRAM) - Emergency and urgent care asthma clinical score

Signs	0	1	2	3
Suprasternal indrawing	Absent		Present
Scalene retractions	Absent		Present
Wheezing	Absent	Expiratory only	Inspiratory and expiratory	Audible without stethoscope/silent chest with minimal air entry
Air entry	Normal	Decreased at bases	Widespread decrease	Absent/minimal
Oxygen saturation on room air	>93%	90 to 93%	<90%
Severity classification		PRAM clinical score
Mild		0 to 4
Moderate		5 to 8
Severe		9 to 12
Impending respiratory failure		12+ following lethargy, cyanosis, decreasing respiratory effort, and/or rising pCO₂

pCO₂: partial pressure of carbon dioxide.

Reproduced from: Chalut DS, Ducharme FM, Davis GM. The Preschool Respiratory Assessment Measure (PRAM): a responsive index of acute asthma severity. J Pediatr 2000; 137:762. Original figure modified for this publication. Table used with the permission of Elsevier Inc. All rights reserved.

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