Advanced Nursing Directives: Integrating Validated Clinical Scoring Systems into Nursing Care in the Pediatric Emergency Department

Table 2

The Pediatric Respiratory Assessment Measure (PRAM). Scores of 0–4 indicate mild disease, 5–8: moderate disease, 9–12: severe disease. SpO₂: Oxygen Saturation.

Signs	0	1	2	3
Suprasternal indrawing	Absent		Present
Scalene retractions	Absent		Present
Wheezing	Absent	Expiratory only	Inspiratory and expiratory	Audible without stethoscope or silent chest with minimal air entry
Air entry	Normal	Decreased to bases	Widespread decrease	Absent/minimal
SpO2 on room air	>95%	92–95%	<92%