O-12 Paediatric Respiratory Assessment Measure (PRAM) Score for Prediction of Admission of Paediatric Patients with Acute Asthma in Three Jamaican Hospitals
Author(s):
A Blackman , M Reid , S French
Year of Presentation:
2025
Objective: To assess the diagnostic performance of the
PRAM score as a predictor of hospital admission in children
presenting with acute exacerbations of asthma, assessed at
triage and first clinical review. To assess the level of agreement between physician gestalt category and the PRAM
score category. To determine the odds of admission per unit
change in PRAM score.
Methods: A multi-centre, prospective cohort study was conducted in the emergency departments of three southeastern Jamaican hospitals. Children between the ages of two and 17 years old who visited the University Hospital of the West Indies (UHWI), Spanish Town Hospital (STH) and Linstead Hospital (LH) for acute asthma exacerbations were selected using convenience sampling. Patient respiratory parameters were assessed by the triage doctor or nurse using data collection forms. PRAM scores were calculated both at initial triage and upon review.
Results: This study with 74 children, mostly male, aged two to 17 years, showed moderate agreement between physician gestalt and PRAM grades at triage and review, with Kappa values of 0.4726 and 0.5478. The AUC for PRAM was 0.8905 at triage and 0.8222 at review, indicating good predictive ability for hospital admissions. PRAM’s Akaike Information Criterion (AIC) of 63.35428 was lower than Gestalt’s 76.71461, suggesting greater efficiency of the PRAM model.
Conclusion: The PRAM score has good predictive ability for hospital admission and performed better than physician gestalt in predicting the need for admission in patients with acute asthma exacerbation.