Archives de pediatrie : organe officiel de la Societe francaise de pediatrie · 2026
Evaluation of the PRAM score for assessing the severity of wheezing episodes in infants under 24 months of age: A prospective observational study in a pediatric emergency department.
СтатьяНаблюдательное исследованиеНазвание и аннотация: Перевод в очереди
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Courselle Anthony, Raghani Juliette, Marguet Christophe, Petat Hortense
Аннотация
BACKGROUND: Recurrent wheezing is a common chronic condition in young children, and episodes often lead to emergency department (ED) visits. The Pediatric Respiratory Assessment Measure (PRAM) score is a validated clinical severity tool widely used for children aged 2 to 17 years to guide management of acute wheezing episodes. However, its validity in children under 24 months remains unestablished.
OBJECTIVES: This prospective observational study aimed to evaluate whether the PRAM can serve as a reliable marker of severity in infant wheezing episodes. We assessed the relationships between the PRAM, admission rates, ED length of stay (LOS), and hospital LOS.
METHODS AND SETTINGS: From July 2022 to February 2023, data were collected through questionnaires completed by attending physicians in the pediatric emergency department at Rouen University Hospital. The study involved 92 infants under 24 months who presented with an acute wheezing episode. Epidemiological, clinical, and treatment data were recorded at baseline and during care, along with patient disposition at discharge.
RESULTS: The cohort had a mean age of 15 months and an overall admission rate of 34.8%. Fifty-seven percent of infants experienced an inaugural episode; 15% of recurrent episodes had not received any home treatment prior to presentation. The PRAM measured at baseline and after the first reassessment (H1) demonstrated strong correlations with admission rates (r = 0.71 and r = 0.90, respectively). Additionally, the PRAM correlated with ED LOS and hospital LOS. Multivariate analysis revealed that only the PRAM at H1 was independently associated with both ED LOS and inpatient LOS.
CONCLUSION: These findings suggest that the PRAM is a valid indicator of the severity of an acute wheezing episode in infants. Measurement at the first clinical reassessment is highly predictive of admission. Therefore, the PRAM may be useful for assessing wheezing episodes in children under 2 years of age.
OBJECTIVES: This prospective observational study aimed to evaluate whether the PRAM can serve as a reliable marker of severity in infant wheezing episodes. We assessed the relationships between the PRAM, admission rates, ED length of stay (LOS), and hospital LOS.
METHODS AND SETTINGS: From July 2022 to February 2023, data were collected through questionnaires completed by attending physicians in the pediatric emergency department at Rouen University Hospital. The study involved 92 infants under 24 months who presented with an acute wheezing episode. Epidemiological, clinical, and treatment data were recorded at baseline and during care, along with patient disposition at discharge.
RESULTS: The cohort had a mean age of 15 months and an overall admission rate of 34.8%. Fifty-seven percent of infants experienced an inaugural episode; 15% of recurrent episodes had not received any home treatment prior to presentation. The PRAM measured at baseline and after the first reassessment (H1) demonstrated strong correlations with admission rates (r = 0.71 and r = 0.90, respectively). Additionally, the PRAM correlated with ED LOS and hospital LOS. Multivariate analysis revealed that only the PRAM at H1 was independently associated with both ED LOS and inpatient LOS.
CONCLUSION: These findings suggest that the PRAM is a valid indicator of the severity of an acute wheezing episode in infants. Measurement at the first clinical reassessment is highly predictive of admission. Therefore, the PRAM may be useful for assessing wheezing episodes in children under 2 years of age.