To determine the association between asthma severity and hospital admission measured by Pediatric Respiratory Assessment Measure (PRAM) score at Indus Hospital and Health Network, Karachi, Pakistan, 2020-2021.

Unaisa Kazi,Mohammad Fareeduddin,Saira Gul Rukh,Saba Laila,Suha Zawawi,Syed Ghazanfar Saleem

doi:10.12669/pjms.38.icon-2022.5783

Abstract

Objectives:To determine the association between asthma severity and the likelihood of hospitalization by using Pediatric Respiratory Assessment Measure (PRAM) score for pediatric patients who present to the emergency department (ED) with mild, moderate or severe asthma exacerbations and those who received standard intensive asthma therapy.Methods:This was a retrospective study conducted in children aged between 2 to 14 years. The data was entered and analysed using Statistical Package for the Social Sciences (SPSS) version 21. To be included in the study, the children must have received “intensive asthma therapy” defined as administration of systemic corticosteroids with three albuterol treatments and ipratropium.Results:A total of 437 patients were enrolled in the study out of which 250 were male and 187 were female. The mean age was 6.1 ± 3.4 years with a minimum age of two and a maximum age of 14 years. The 4-hour PRAM score (AUC = 0.88) overall significantly improved the predictive value of admission (p value <0.001) as compared to the PRAM score calculated at triage (AUC = 0.81).Conclusion:The 4-hour PRAM score is the best predictor for the need of hospitalization. It is suggested that these results are applied clinically in the pediatric ED to improve patient flow and to better facilitate intensive therapy of patients at triage to decrease the need for hospitalization.

Highlights

Many authentic scoring systems such as, the Paediatric Respiratory Assessment Measure (PRAM) score, Respiratory Rate-Accessory Muscle Use-Decrease breath sounds (RAD) score and Paediatric Asthma Severity score are in use for classifying the severity of asthma, and guiding
For Pediatric Respiratory Assessment Measure (PRAM) scoring, mechanisms of wheezing, entry of air, scalene muscle contraction, suprasternal retraction and oxygen saturation are all incorporated into a score that is used for children aged between 2 to 17 years that present with acute exacerbation of asthma
As compared to the PRAM score, Clinical Respiratory Score (CRS) takes into account the mental status and appearance of the child and does not require expert training to use. Another prospective study studied the comparison between Wood’s and PRAM score to determine which was a better predictor of severity of childhood asthma exacerbations and the results showed that both scores were promising in predicting the outcome and severity in children

Summary

Introduction

Asthma is a chronic respiratory disease that affects people of all ages and is characterized by Correspondence: November 28, 2021 episodic and reversible attacks of wheezing, chest tightness, shortness of breath, and coughing. Estimations show that approximately 30% of asthma-related emergency visits in the pediatric age group result in hospitalization. In Pakistan, the prevalence of asthma among children ranges from 15 to 20% in different areas of the country. Many authentic scoring systems such as, the Paediatric Respiratory Assessment Measure (PRAM) score, Respiratory Rate-Accessory Muscle Use-Decrease breath sounds (RAD) score and Paediatric Asthma Severity score are in use for classifying the severity of asthma, and guidingPak J Med Sci January 2022 Vol 38 No 2 Special Issue www.pjms.org.pk 345 treatment. For PRAM scoring, mechanisms of wheezing, entry of air, scalene muscle contraction, suprasternal retraction and oxygen saturation are all incorporated into a score that is used for children aged between 2 to 17 years that present with acute exacerbation of asthma. Estimations show that approximately 30% of asthma-related emergency visits in the pediatric age group result in hospitalization.. Many authentic scoring systems such as, the Paediatric Respiratory Assessment Measure (PRAM) score, Respiratory Rate-Accessory Muscle Use-Decrease breath sounds (RAD) score and Paediatric Asthma Severity score are in use for classifying the severity of asthma, and guiding. For PRAM scoring, mechanisms of wheezing, entry of air, scalene muscle contraction, suprasternal retraction and oxygen saturation are all incorporated into a score that is used for children aged between 2 to 17 years that present with acute exacerbation of asthma. Authorised scorings that guide evidencebased management are present, there still remains substantial underuse of the proven treatments of asthma.. Research shows that up to 30% of children who present with severe asthma in the ED are hospital admissible.

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Conclusion