The pediatric respiratory assessment measure as a predictor of hospitalization in the management of asthma exacerbations: an observational study

OBJECTIVE: To evaluate the Pediatric Respiratory Assessment Measure (PRAM) score for hospital admission and prolonged stay risk stratification in the emergency department (ED) at different time points. METHOD: Retrospective cohort study using prospectively collected protocol data (August 2023-March 2025) at a tertiary pediatric ED. Patients aged 2-17 years with acute asthma exacerbations were included; those with systemic comorbidities, other chronic lung diseases, or confounding acute conditions were excluded. PRAM was assessed hourly (PRAM 0 to 4). Outcomes were hospital admission and prolonged ED stay (> 3 h). RESULTS: A total of 428 visits were analyzed (35.0% hospital admission rate). PRAM demonstrated satisfactory discriminatory capacity for admission at triage (AUC: 0.791; 95% CI: 0.745-0.836; p < 0.001), with optimized accuracy during serial assessments, performing best at the second hour (PRAM 2; AUC: 0.829; 95% CI: 0.773-0.885; p < 0.001). For predicting prolonged ED stay, the score showed moderate accuracy at the second hour (AUC: 0.677; p < 0.001), with no significant correlation between sequential scores and time to admission decision (p > 0.05). CONCLUSIONS: PRAM is a valuable, dynamic risk-stratification tool for pediatric asthma exacerbations. Serial assessments provide superior prognostic accuracy compared to a single static measurement at admission by actively reflecting therapeutic response. Although its ability to predict operational outcomes is restricted by non-clinical factors, the score demonstrates consistent utility for standardizing clinical assessment and supporting medical disposition in the ED.