AN OBSERVATIONAL STUDY ON PRAM SCORE IN PREDICTING DISPOSITION AND ITS BEST HOUR OF PREDICTION IN EMERGENCY SETTING AMONG CHILDREN WITH MODERATE ACUTE EXACERBATION OF BRONCHIAL ASTHMA IN HOSPITAL TUANKU JAAFAR SEREMBAN

Abstract

Introduction: To determine the best hour of Paediatric Respiratory Assessment Measure (PRAM) score to predict disposition and to determine the correlation between the patients disposition and PRAM score trend for children presented with moderate exacerbation of bronchial asthma.

Methodology: This is prospective observational cohort study of paediatric with moderate acute exacerbation of bronchial asthma over 5 months in Hospital Tuanku Jaafar. It is a secondary analysis of data examining the effectiveness of an asthma medical directive in the Emergency Department. PRAM score is documented hourly up to patient’s disposition. Logistic regression model were used to predict admission based on PRAM score and the AUC was calculated for each hour. Discharged patients were followed up for any revisit within 24hours.

Results:  60 patients aged between 2 to 12 years participated in the study.  PRAM scores at hour 4 (AUC0.875, p – 0.04, CI – 0.713,1.0) and at hour 5 (AUC0.906, p – 0.029, CI – 0.768,1.0) best predicts the need for hospital admission. For discharge status, PRAM score at hour 5 was significantly most predictive with an AUC of 90% (95%CI -0.753 to 1.0). The sensitivity of the PRAM score is 100% and specificity 12.5% for the 4^th and 5^th hour during admission and sensitivity of 86.7% during discharge. The difference of PRAM scores between arrival and discharge of more than 3 (AUC0.875, p 0.00, CI – 0.781,0.970) has positive association (Odd Ratio – 3.973, p – 0.001) with the status of disposition with the sensitivity of 90% and low specificity of 16.2%. 

Discussion/Conclusion:  PRAM score at 4th and 5th hour has best predictive value for patient disposition. Reduction of PRAM score of more than 3 has high association with safe discharge in patients presented to emergency department with moderate exacerbation of bronchial asthma. This allows prevention of overcrowding and inappropriate discharges in emergency department.