Comparison between Paediatric Respiratory Assessment Measure (PRAM) and Modified Pulmonary Index Score (MPIS) to Assess Acute Asthma Exacerbation in 2-17 years paediatric Age Group - A Prospective Study

Abstract

Objective assessment of asthma severity in children is conventionally performed using spirometry. However, many children, particularly those under six years of age, are unable to reliably perform spirometry during acute exacerbations or in emergency settings. Assessing severity in this population is further complicated by variations in age and developmental stage. Consequently, several clinical scoring systems have been developed to estimate disease severity objectively. Among these, the Paediatric Respiratory Assessment Measure (PRAM)   and the Modified Pulmonary Index Score (MPIS) have demonstrated good concurrent validity and responsiveness in predicting asthma severity. A comparative evaluation of these two tools may help identify the more reliable scoring system for assessing acute exacerbations in children. The objectives of this study were to compare the PRAM and MPIS scoring systems in assessing the severity of acute asthma exacerbations in children aged 2–17 years, and to evaluate their predictive utility for hospitalization and thus timely initiation of therapy.

Methods: This was a prospective observational study conducted on 70 children aged 2–17 years admitted to the PICU with acute exacerbation of asthma. Each child was assessed using the Paediatric Respiratory Assessment Measure (PRAM) and the Modified Pulmonary Index Score (MPIS) at admission (0 hours) and at 6, 24, and 48 hours. The cumulative PRAM and MPIS scores were compared individually with the Global Initiative for Asthma (GINA) 2020 guidelines. Evaluation and management of all patients were carried out in accordance with GINA 2020 recommendations.

Results:
The Modified Pulmonary Index Score (MPIS) demonstrated a sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall accuracy of 100%, indicating excellent diagnostic performance. In comparison, the Paediatric Respiratory Assessment Measure (PRAM) showed a sensitivity of 69.5%, specificity of 90.9%, PPV of 97.6%, NPV of 35.7%, and accuracy of 72.9%. A statistically significant reduction in MPIS scores was observed at 0, 6, and 24 hours, while PRAM showed significance only at 6 hours (p < 0.001). MPIS also showed a stronger correlation with the duration of hospital stay (p-value = 0.01).

Conclusion:
MPIS demonstrated superior predictive validity and greater accuracy than PRAM in assessing disease severity and predicting duration of hospitalization among children with acute exacerbation of asthma.