This version was machine-translated from German and has not been medically reviewed. The authoritative version is the German version.

PRAM score (asthma)

Pediatric Respiratory Assessment Measure: severity of an acute asthma exacerbation, 0–12 points

Oxygen saturation

≥ 95 % 0 92–94 % 1 < 92 % 2

Suprasternal retractions

absent 0 present 2

Contraction of the scalene muscles

absent 0 present 2

Air entry

In case of asymmetry, the most affected lung field counts (apex to base, right or left, front or back).

normal 0 reduced at the base 1 reduced at apex and base 2 minimal or absent 3

Wheezing

In case of asymmetry, the two most affected auscultation zones count, regardless of their location.

absent 0 expiratory only 1 inspiratory (± expiratory) 2 audible without stethoscope or “silent chest” (minimal or absent air entry) 3

Severity by PRAM sum

Total	Designation according to source
0–3	mild
4–7	moderate
8–12	severe

Table 1 of the CPS position statement: 0–3 mild, 4–7 moderate, 8–12 severe. As additional signs of severity, the statement lists nasal flaring, decreased activity or poor feeding, or inability to speak in full sentences, as well as impaired consciousness, agitation, drowsiness or confusion as signs of cerebral hypoxemia and impending respiratory failure.

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Sources

Managing an acute asthma exacerbation in children (Position statement, Acute Care Committee, Paediatric Emergency Medicine Section; Paediatr Child Health 2021) – Table 1: Classification of asthma severity using the PRAM score Canadian Paediatric Society (Trottier ED, Chan K, Allain D, Chauvin-Kimoff L), 2021. Guideline / position statement (freely accessible, full text read)
The Pediatric Respiratory Assessment Measure: a valid clinical score for assessing acute asthma severity from toddlers to teenagers (J Pediatr 152:476–480) Ducharme FM, Chalut D, Plotnick L et al., 2008. Original paper (validation 1–17 years; not freely accessible – wording via CPS-ASTHMA-2021)

Scientific basis last reviewed: September 2026.

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Note

Calculation aid for healthcare professionals. Percentiles and z-scores describe the position of a measured value in the reference population; clinical assessment remains with the treating physician.