Comparison between pediatric respiratory assessment measure (PRAM) score and Wood's asthma score to assess acute asthma exacerbation.

Abstract

Wood's score, the assessment of childhood respiratory failure, has been used to assess childhood acute asthma severity in Thailand since 19th century. However, PRAM score, which is increasingly used in Western countries has not been evaluated among Thai children with asthma. This study aims to determine whether Wood or PRAM score is better prediction of severity of childhood asthma exacerbation. The prospective comparative study of severity asthma score was performed in asthmatic children, 2-18 years old, with acute asthma exacerbation at Queen Sirikit National Institute of Child Health. PRAM and Wood's score were separately determined by 2 physicians. The patients were further assessed at 0, 4 or 24 hours after their admissions. The asthma treatment followed GINA guideline. There were 80 asthmatic patients, mean aged 5.71 ± 2.95 years. The admission rate was 28.8% with the mean length of stay = 4 ± 1 days. PRAM was correlated with Wood's score (Spearman's correlation p = 0.900, p < 0.001 at triage, and = p0.981, p < 0.001). The highlight of this study is the finding that intraclass correlation of PRAM is better than Wood asthma score (ICC = 0.944; 95%CI 0.913-0.964, 0.898; 95%CI 0.841-0.935, respectively). ROC indicated Wood's score ≤ 4 and PRAM ≤ 5, in the requirement for admission. PRAM and Wood's score are both promising in prediction of severity and outcome of childhood asthma exacerbation.