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PRAM teaching module

As part of this teaching module, you will have the opportunity to familiarize yourself with the PRAM, a 12-point score developed and validated in children 1 to 17 years old. This score is used to assess the severity of an asthma exacerbation and the response to treatment. By completing this module, you will be able to identify the PRAM criteria, to rate them and determine with accuracy and precision the final PRAM score.

Furthermore, by completing this online teaching module you will get credits of continuing medical education valid for your professional association.

Objectifs

Disclaimer

This professional development program pertains to the Pediatric Respiratory Assessment Measure ("PRAM"), a clinical score developed and validated for children aged 1-17 years. The PRAM serves to assess the severity of an asthma exacerbation and its response to treatment to apply severity-specific treatment in conformity with national and international guidelines.

THE PRAM TEACHING MODULE IS DESIGNED ONLY FOR PROFESSIONAL DEVELOPMENT. THE PRAM SCORE IS INTENDED TO BE USED IN THE CLINICAL ASSESSMENT OF THE SEVERITY OF AN EPISODE OF ACUTE AIRWAY OBSTRUCTION DUE TO ASTHMA. IT IS AN AID TO THE CLINICAL ASSESSMENT AND SHALL NOT BE USED TO REPLACE OR OVERRULE A LICENSED HEALTH CARE PROFESSIONAL'S JUDGEMENT ABOUT ASTHMA SEVERITY.

All copyright and other intellectual property rights in the PRAM and the PRAM Teaching Module are the sole and exclusive property of Dr. Francine M. Ducharme. Any unauthorized use, copy or modification of the PRAM Teaching Module is strictly forbidden.

Why a clinical score?

National and international guidelines on the treatment of an acute asthma exacerbation vary according to the severity of airway obstruction. An accurate assessment of severity is therefore essential.

Although spirometry is recognized as the gold standard for assessing asthma severity, close to 100% of preschoolers and almost 50% of school-aged children cannot reproducibly perform the manoeuvre required for spirometry during an acute asthma exacerbation.

A clinical score offers an interesting alternative because it is applicable to all, irrespective of the child’s age.

How does the PRAM perform for assessing the severity of an asthma flare-up?

The PRAM score correlates with airway resistance.1 A change in PRAM score correlates with a change in airway resistance. Moreover, the PRAM score measured at triage predicts the rate of hospital admission2 and has been classified into three severity levels as follows:

Score 0-3 4-7 8-12
Severity Mild Moderate Severe

The hospitalisation rate of children with a PRAM of 0 to 3 (mild obstruction) is inferior to 10%. It is between 10% and 40% those with a PRAM of 4 to 7 (moderate obstruction) and superior to 50% for those with a PRAM of 8 to 12 (severe obstruction)


1 Chalut DS et al. J Pediatr. 2000;137(6):762-8
2 Ducharme FM et al. J Pediatr. 2008;152(4):476-80, 480.e1

General goals and objectives

The aim of this teaching module is to facilitate the acquisition of skills to accurately assign the PRAM score in acutely ill children, in order to apply severity-specific treatment in conformity with national guidelines.

Following completion of this online module, you will be able to:

  1. Recognize the five criteria of the Pediatric Respiratory Assessment Measure (PRAM);
  2. Assign the PRAM score accurately and precisely in children aged 1-17 years;
  3. Establish a PRAM score, regardless of the severity of the asthma exacerbation, the asymmetry in pulmonary auscultation, or any other pitfalls in the physical examination;
  4. Assess the level of asthma severity (mild, moderate, severe) using the PRAM score;
  5. Apply the PRAM score in your own clinical practice to assess the severity of an acute exacerbation and the response to treatment 

 
About this page
Updated on 10/26/2016
Created on 9/20/2016
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