526 - Comparing Pediatric Respiratory Assessment Measure (PRAM) and Pediatric Asthma Severity Score (PASS) in Children Aged 2-12 Years with Viral-Induced Wheezing in a Multiethnic Community Hospital

Publication Number: 4514.526

Amir Ehsani, Flushing Hospital Medical Center, Flushing, NY, United States; Bilal Manzoor, Flushing Hospital Medical Center, Flushing, NY, United States; Matthew Roland, Medisys Health Network, VALLEY STREAM, NY, United States; Lily Q.. Lew, Flushing Hospital Medical Center, Flushing, NY, United States; Gagan Gulati, Flushing Hospital Medical Center, Flushing, NY, United States

Background: Wheezing is a common respiratory symptom in children. A viral infection can trigger wheezing. Pediatric Respiratory Assessment Measure (PRAM) and Pediatric Asthma Severity Score (PASS) are two validated asthma severity scores based on physical findings in pediatrics. There is a paucity of data on the two asthma severity scores on viral-induced wheezing.

Objective: To compare PRAM and PASS in children with viral-induced wheezing and disposition.

Design/Methods: A retrospective chart review of children aged 2-12 years seen in the emergency department (ED) with wheezing or asthma and viral testing between January 1, 2022 and December 31, 2024. Data extracted from EHR include demographics (age, gender, ethnicity), result of nasopharyngeal swab for respiratory viral test and disposition. PRAM (0-12 for five items) was assigned mild (0-3), moderate (4-7) or severe (8-12); PASS (0-6 for three items) was assigned mild (0-1) or severe (2-6). Data were analyzed using R software; p< 0.05 was considered statistically significant.

Results: Of 202 charts reviewed for wheezing and viral testing, more than half were male (61%) with a median age of 4.0 years (3.0,7.0). Two-thirds (64%) were Hispanic and a fifth (20%) were Asian reflective of our community. Half of the total patients tested positive for rhinovirus (50%), followed by respiratory syncytial virus in 15%, influenza in 9%, and SARS-CoV-2 in 1%. Wheezing without a history of asthma was in more than half of the patients (59%). Most patients were admitted to the inpatient service (70%), few transferred to tertiary care center (3%) and the remainder managed in the ED. Of the patients managed in ED, the median PRAM was 1.0 (1.0, 3.0) and PASS of 0.0 (0.0, 1.0), p< 0.001. Of the patients hospitalized, the median PRAM was 5.0 (4.0, 6.0) compared to the median PASS of 2.0 (2.0, 3.0), p< 0.001. Higher PRAM (OR=0.22, 95% CI=[0.13–0.33] and higher PASS (OR=0.04, 95% CI = [0.01–0.08], p< 0.001) significantly predicted likelihood for hospitalization, p< 0.001. Despite significant positive correlation between PRAM and PASS (r [200] = 0.80, 95% CI: [0.75–0.84], p< 0.001), PRAM and PASS correlated well for mild disease and PASS was more likely to assign moderate as severe disease (χ2[1] = 46.08, p< 0.001).

Conclusion(s): In our small multiethnic sample, wheezing is often in pre-school age Hispanic males for three items testing positive for rhinovirus and having no history of asthma. PRAM was better in determining the probability of hospitalization in viral-induced wheezing.