The usefulness of PRAM score in assessing the severity and outcome of an acute exacerbation of wheeze in children

<>Title: The usefulness of PRAM score in assessing the severity and outcome of an acute exacerbation of wheeze in children <>Background :

Clinical scores  are valuable tools to assess asthma severity in children. Among the available scores the Pediatric Respiratory Assessment Measure (PRAM) score is very useful one .

Aims of study:

            To study the usefulness of PRAM score in assessing the severity and outcome of an acute exacerbation of wheeze in children aged 1-17yrs.To identify the PRAM score predicting the need for hospitalization and ICU care. <>Period of Study:

August 2008 to Dec 2009

Study design:

            This is a prospective cohort study

Sample size:

            127 children was calculated based on the pilot study  from the initial 20 children. Assuming an alpha error of 5% and 80% power.

Methodology :

Children diagnosed to have asthma based on GINA guidelines 2008 came with acute exacerbation of wheeze were enrolled in the study ,had PRAM scores done at admission and following each treatment administered in the ER.  All children were triaged and treated as mild, moderate, severe exacerbation and appropriate treatment was given in  the emergency room and  the outcome was recorded. Statistical Analysis done using SPSS – 15 version. Relationship between admission scores and the outcome were evaluated using paired t tests and one way ANOVA f test. Receiver operator curve analysis(ROC)was used to identify score predicting admission and need for ICU care.

Results :

Of the 127 children 52% were aged   1 - 3 years, 27.6% between the ages of 3 – 6 years and 20.4% between the ages of 6 - 17 years . The mean PRAM scores at admission and discharge in all the 3 age groups was 7.3 and  4.1 respectively ,this  difference is statistically significant. ROC score of 5.5 and above had 89% sensitivity and 64% specificity for admission.

Conclusion:

PRAM scores  is a useful score to assess asthma severity in children and a  score of 6 predicted the need for hospitalization and score of 9 predicted the need for ICU care .