To determine the association between asthma severity and hospital admission measured by Pediatric Respiratory Assessment Measure (PRAM) score at Indus Hospital and Health Network, Karachi, Pakistan, 2020-2021

Unaisa Kazi; Saira Gul Rukh; Suha Zawawi; Saba Laila; Mohammad Fareeduddin; Syed Ghazanfar Saleem

doi:10.12669/pjms.38.ICON-2022.5783

To determine the association between asthma severity and hospital admission measured by Pediatric Respiratory Assessment Measure (PRAM) score at Indus Hospital and Health Network, Karachi, Pakistan, 2020-2021

Pak J Med Sci. 2022 Jan;38(2):345-350. doi: 10.12669/pjms.38.ICON-2022.5783.

Authors

Unaisa Kazi¹, Saira Gul Rukh², Suha Zawawi³, Saba Laila⁴, Mohammad Fareeduddin⁵, Syed Ghazanfar Saleem⁶

Affiliations

¹ Dr. Unaisa Kazi, MCPS, Specialist Pediatrics Emergency, Indus Hospital and Health Network (IHHN), Korangi Crossing, Karachi, Pakistan.
² Dr. Saira Gul Rukh, MBBS, Medical Officer, Emergency Department, Indus Hospital and Health Network (IHHN), Korangi Crossing, Karachi, Pakistan.
³ Dr. Suha Zawawi, MBBS, Emergency Department, Indus Hospital and Health Network (IHHN), Korangi Crossing, Karachi, Pakistan.
⁴ Dr. Saba Laila Aslam, FCPS, Head of Pediatric Emergency Department, Indus Hospital and Health Network (IHHN), Korangi Crossing, Karachi, Pakistan.
⁵ Dr. Mohammad Fareeduddin, FCPS, Chair, Pediatric Medicine & Allied, Indus Hospital and Health Network (IHHN), Korangi Crossing, Karachi, Pakistan.
⁶ Dr. Syed Ghazanfar Saleem, FCPS, Chair Emergency Medicine, Indus Hospital and Health Network (IHHN), Korangi Crossing, Karachi, Pakistan.

Abstract

Objectives: To determine the association between asthma severity and the likelihood of hospitalization by using Pediatric Respiratory Assessment Measure (PRAM) score for pediatric patients who present to the emergency department (ED) with mild, moderate or severe asthma exacerbations and those who received standard intensive asthma therapy.

Methods: This was a retrospective study conducted in children aged between 2 to 14 years. The data was entered and analysed using Statistical Package for the Social Sciences (SPSS) version 21. To be included in the study, the children must have received "intensive asthma therapy" defined as administration of systemic corticosteroids with three albuterol treatments and ipratropium.

Results: A total of 437 patients were enrolled in the study out of which 250 were male and 187 were female. The mean age was 6.1 ± 3.4 years with a minimum age of two and a maximum age of 14 years. The 4-hour PRAM score (AUC = 0.88) overall significantly improved the predictive value of admission (p value <0.001) as compared to the PRAM score calculated at triage (AUC = 0.81).

Conclusion: The 4-hour PRAM score is the best predictor for the need of hospitalization. It is suggested that these results are applied clinically in the pediatric ED to improve patient flow and to better facilitate intensive therapy of patients at triage to decrease the need for hospitalization.

Keywords: Asthma; Paediatric Respiratory Assessment Measure.