Use of a standardized asthma severity score to determine emergency department disposition for paediatric asthma: A cohort study

Pavan Judge, Raymond Tabeshi, Ren Jie Yao, Garth Meckler, Quynh Doan

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


Background: We recently introduced a clinical practice pathway for the management of asthma that uses the Pediatric Respiratory Assessment Measure (PRAM) to guide emergency department (ED) treatment and disposition. The pathway recommends discharge for patients who achieve improvement to PRAM <4 at 1 hour after the last bronchodilator. We evaluated practice variation and patient outcomes associated with PRAM-directed disposition recommendations. Methods: We conducted a retrospective cohort study of children aged 2 to 17 years treated for moderate asthma (PRAM score 4.7) using our asthma clinical pathway. We measured 1) the proportion of children discharged per pathway criteria who returned to our ED within 24 hours and 2) the proportion of children observed beyond the pathway discharge criteria who deteriorated (PRAM .4). Results: We analyzed 385 patient records from September 2013 to February 2015. Among 145 (37.7%) patients discharged per pathway criteria, 4 (4/145; 2.8%) returned within 24 hours. The remaining 240 (62.2%) were observed beyond the pathway discharge criteria; 76/240 (31.7%) had a subsequent deterioration (PRAM score . 4) and 25/240 (10.4%) were hospitalized. Of those who deteriorated, 46/76 (60.5%) worsened within the first additional hour of observation. Conclusion: We observed significant deviation from our PRAM-directed pathway discharge criteria and that a significant proportion of observed patients experienced clinical deterioration beyond the first hour of observation. We recommend observing children with moderate asthma for 2 or 3 hours from last bronchodilator therapy if PRAM < 4 is maintained, to capture the majority (97.7% or 99.7%) of patients who require further intervention and hospitalization.

Original languageEnglish (US)
Article numberpxy125
Pages (from-to)227-233
Number of pages7
JournalPaediatrics and Child Health (Canada)
Issue number4
StatePublished - Jun 21 2019
Externally publishedYes


  • Asthma
  • Clinical decision tool
  • Disposition from emergency

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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