Pediatric Respiratory Assessment Measure (PRAM) Score Calculator

O2 saturation
Suprasternal indentation
Contraction of the scalene muscles
Vesicular murmur
Wheezing



Score :

Severity :

What is the PRAM Score Calculator?

The PRAM Score Calculator (Pediatric Respiratory Assessment Measure) is a validated clinical tool designed to help evaluate the severity of asthma attacks in children. It is commonly used in emergency rooms, clinics, and other healthcare settings to assess respiratory distress quickly and reliably. By assigning a score based on five specific physical signs, the calculator provides a numeric result that reflects the overall intensity of the child’s asthma symptoms.

These five signs include:

  • O2 Saturation – the percentage of oxygen in the blood, measured with a pulse oximeter.
  • Suprasternal Indentation – inward movement of the skin at the top of the chest during breathing.
  • Scalene Muscle Contraction – visible use of neck muscles during respiration.
  • Vesicular Murmur – the quality of breath sounds heard through a stethoscope.
  • Wheezing – abnormal whistling sounds during breathing, which can indicate airway narrowing.

Each of these indicators is scored based on severity, and the sum of the scores determines the child’s overall PRAM score, which falls into one of three categories:

  • 0–3: Mild asthma symptoms
  • 4–7: Moderate asthma symptoms
  • 8–12: Severe asthma symptoms

The PRAM Score Calculator is not meant to replace a professional medical evaluation, but it can support healthcare providers and even caregivers in recognizing when a child’s condition requires urgent attention. It’s especially helpful in monitoring a child’s response to treatment over time, offering a standardized way to track changes in their breathing and overall respiratory status.

Who Should Use This Calculator?

The PRAM Score Calculator is intended for use by healthcare professionals, including pediatricians, emergency physicians, nurses, respiratory therapists, and other trained medical staff. It provides a quick and structured way to assess the severity of asthma symptoms in children aged 2 to 17 years. This tool helps guide clinical decisions regarding treatment, hospitalization, or continued observation.

Although the calculator is primarily designed for medical environments, it can also be a helpful reference for parents or caregivers who have been educated by their child’s healthcare provider. When used correctly, it allows them to monitor symptom changes at home and know when to seek immediate medical attention.

However, it’s important to note that the PRAM Score Calculator is not a diagnostic tool and should not be used by untrained individuals to make treatment decisions on their own. If you're unsure about your child's symptoms or condition, always consult a qualified healthcare professional.

How to Use the PRAM Calculator

Using the PRAM Score Calculator is simple and takes only a few moments. It involves selecting the most accurate description for five specific signs of respiratory distress in a child. Each selection is assigned a point value, and the total score helps determine the severity of the child's asthma symptoms. Follow these steps:

  1. Assess O2 Saturation: Measure the child’s oxygen level using a pulse oximeter. Select the appropriate range:
    • 0 points – 95% or higher
    • 1 point – 92% to 94%
    • 2 points – Less than 92%
  2. Check for Suprasternal Indentation: Observe the area above the breastbone during inhalation.
    • 0 points – No indentation
    • 2 points – Indentation is present
  3. Look for Scalene Muscle Contraction: Watch the neck for signs of muscle use while the child breathes.
    • 0 points – Not visible
    • 2 points – Contraction is present
  4. Evaluate Vesicular Murmur (Breath Sounds): Use a stethoscope to listen to the lungs. Choose the option that best matches the sound:
    • 0 points – Normal breath sounds
    • 1 point – Diminished at the base
    • 2 points – Diminished at apex and base
    • 3 points – Minimal or absent
  5. Assess Wheezing: Listen for wheezing sounds and note how prominent they are:
    • 0 points – No wheezing
    • 1 point – Wheezing during exhalation only
    • 2 points – Wheezing during inhalation and/or exhalation
    • 3 points – Wheezing audible without a stethoscope or absent due to poor airflow

Once you’ve selected the appropriate response for each category, click the "Calculate" button. The calculator will automatically sum the points and display:

  • Score: The total number of points
  • Severity: Categorized as Mild (0–3), Moderate (4–7), or Severe (8–12)

Use the result to help determine the urgency of care needed. Always consult a healthcare provider if you are unsure or concerned about the child’s condition.

PRAM Score Components Explained

The PRAM Score is based on five key physical signs that indicate how well a child is breathing during an asthma episode. Each component is scored individually, and the total score helps determine the severity of the symptoms. Here’s a breakdown of each component:

1. O2 Saturation

This measures the level of oxygen in the child’s blood, typically using a fingertip pulse oximeter. A lower oxygen saturation level can signal more severe respiratory distress.

  • 0 points – 95% or higher (normal)
  • 1 point – 92% to 94% (slightly low)
  • 2 points – Less than 92% (concerning)

2. Suprasternal Indentation

This refers to visible inward pulling of the skin above the breastbone during inhalation, which indicates labored breathing. It can be a sign of upper airway obstruction.

  • 0 points – Absent
  • 2 points – Present

3. Contraction of the Scalene Muscles

These are muscles located on the sides of the neck. Their use during breathing suggests the child is working harder to inhale, which can signal worsening respiratory effort.

  • 0 points – Absent
  • 2 points – Present

4. Vesicular Murmur (Breath Sounds)

This describes the quality and strength of breath sounds heard through a stethoscope. Diminished sounds may indicate poor air entry into the lungs.

  • 0 points – Normal breath sounds
  • 1 point – Diminished at the base of the lungs
  • 2 points – Diminished at both the apex and base
  • 3 points – Minimal or absent breath sounds

5. Wheezing

Wheezing is a high-pitched sound caused by narrowed airways. The presence and severity of wheezing can help determine how restricted the airflow is.

  • 0 points – No wheezing
  • 1 point – Wheezing only on exhalation
  • 2 points – Wheezing on both inhalation and/or exhalation
  • 3 points – Wheezing audible without a stethoscope or completely absent (due to very poor airflow)

Each of these components gives insight into how the child is breathing. By combining their scores, the PRAM calculator provides a helpful snapshot of the child’s asthma severity at that moment.

Understanding Your PRAM Score

After you use the PRAM Score Calculator and enter your observations, you’ll receive a total score between 0 and 12. This score reflects the severity of the child’s asthma symptoms at the time of assessment. Understanding what the score means can help guide decisions about treatment and whether further medical attention is needed.

Mild (0–3)

A score in this range indicates that the child is experiencing mild asthma symptoms. Breathing is relatively stable, and there are only minor signs of respiratory distress. Treatment at home with prescribed medication may be sufficient, but continued monitoring is important.

Moderate (4–7)

A score between 4 and 7 suggests moderate respiratory distress. The child may be showing more noticeable symptoms such as increased wheezing, use of neck muscles for breathing, or a drop in oxygen saturation. Medical attention is likely needed to adjust treatment, and close observation is essential to ensure symptoms don’t worsen.

Severe (8–12)

A score of 8 or higher means the child is in severe distress. Symptoms may include low oxygen levels, poor air movement, and visible effort in breathing. Immediate medical care is required. This may involve emergency treatment, possible hospitalization, and close monitoring by healthcare professionals.

What to Do with the Result

Once you receive the PRAM Score result and the severity level (Mild, Moderate, or Severe), it's important to take appropriate action based on the child's condition. The score provides a snapshot of the child’s current respiratory status, and it can help guide your next steps. Here's what to do depending on the score:

If the score is Mild (0–3):

The child's symptoms are currently mild. You may continue with their usual asthma management plan, including using prescribed reliever medications as needed. Monitor the child closely for any changes, and ensure they are in a calm, well-ventilated environment. If symptoms begin to worsen, reassess and seek medical advice.

If the score is Moderate (4–7):

The child is showing signs of moderate respiratory distress. You should contact a healthcare provider or visit a clinic for further evaluation. Additional treatment such as bronchodilators or corticosteroids may be necessary. Monitor the child frequently and be prepared to seek emergency care if the symptoms escalate.

If the score is Severe (8–12):

This score indicates a medical emergency. The child is likely experiencing significant breathing difficulty, and urgent medical attention is required. Go to the nearest emergency department or call emergency services immediately. Do not delay treatment.

Disclaimer and Medical Advice

The PRAM Score Calculator is intended to be an educational and supportive tool for assessing the severity of asthma symptoms in children. While it is based on a clinically validated scoring system, it is not a substitute for professional medical evaluation, diagnosis, or treatment.

This calculator is designed for use by healthcare providers and individuals who have been instructed by a medical professional. If you are a parent or caregiver, do not rely solely on this tool to make critical healthcare decisions. Always consult a qualified physician or seek emergency medical care if a child is having difficulty breathing, appears very tired, has bluish lips or skin, or shows any signs of serious illness.

The creators of this tool make no guarantees about its accuracy in all situations and disclaim any liability for decisions made based on its use. Use this calculator as a guide—not as a final authority—when evaluating a child’s condition.

In case of a medical emergency, call your local emergency number or go to the nearest hospital immediately.

References

  • The Pediatric Respiratory Assessment Measure: A Valid Clinical Score for Asthma Severity – Ducharme FM et al. – 2008 – Pediatrics Journal
  • Nelson Textbook of Pediatrics – Kliegman RM, St. Geme JW – 2023 – Elsevier
  • Pathophysiology: The Biologic Basis for Disease in Adults and Children – McCance KL, Huether SE – 2022 – Elsevier
  • A Practice of Anesthesia for Infants and Children – Cote CJ, Lerman J, Anderson BJ – 2018 – Elsevier