Chalut D S, Ducharme F M, Davis G M
Department of Pediatrics, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec,Canada.
J Pediatr. 2000 Dec;137(6):762-8. doi: 10.1067/mpd.2000.110121.
To elaborate and validate a Preschool Respiratory Assessment Measure (PRAM) that would accurately reflect the severity of airway obstruction and the response to treatment in young patients with asthma.
A prospective cohort study was performed in 217 children aged 3 to 6 years who presented to a pediatric emergency department with acute asthma. Respiratory resistance measured by forced oscillation served as a gold standard. Children were randomized to either the test group, in which multivariate analyses were performed to elaborate the PRAM, or the validation group, in which the characteristics of the PRAM were tested.
For the test group (N = 145), the best multivariate model contained 5 variables: wheezing, air entry, contraction of scalenes, suprasternal retraction, and oxygen saturation. In the validation group (N = 72), the PRAM correlated substantially with the change in resistance (r = 0.58) but modestly with the % predicted resistance measured before (r = 0.22) and after bronchodilation (r = 0.36). A change of 3 (95% CI: 2.2, 3.0) indicated a clinically important change.
PRAM appears to be a responsive but moderately discriminative tool for assessing acute asthma severity. This measure, designed for preschool-aged children, has been validated against a concurrent measure of lung function.
精心制定并验证一种学龄前儿童呼吸评估量表（PRAM），该量表能准确反映哮喘患儿气道阻塞的严重程度及对治疗的反应。
对217名3至6岁因急性哮喘就诊于儿科急诊科的儿童进行了一项前瞻性队列研究。以强迫振荡法测量的呼吸阻力作为金标准。将儿童随机分为试验组（对其进行多变量分析以制定PRAM）和验证组（对PRAM的特征进行测试）。
对于试验组（N = 145），最佳多变量模型包含5个变量：哮鸣音、呼吸音、斜角肌收缩、胸骨上窝凹陷和血氧饱和度。在验证组（N = 72）中，PRAM与阻力变化显著相关（r = 0.58），但与支气管扩张前（r = 0.22）和支气管扩张后（r = 0.36）预测阻力百分比的相关性一般。变化值为3（95% CI：[2.2, 3.0]）表明有临床意义的变化。
PRAM似乎是一种用于评估急性哮喘严重程度的反应灵敏但鉴别能力一般工具。这种专为学龄前儿童设计的评估方法已通过与同时测量的肺功能指标进行验证。
