What it is
The Pediatric Asthma Score (PAS) grades the severity of an acute asthma exacerbation in a child from respiratory rate plus four clinical signs. It runs 5–15 and is used to trend response to bronchodilators and to standardise escalation decisions in the emergency setting.
This is not the appendicitis PAS. They share an acronym only — this score is about wheeze and work of breathing, not abdominal pain.
The five components
Respiratory rate is scored 1–3 against an age band; the other four signs are each scored 1–3.
Respiratory-rate points (breaths/min):
| Age | 1 point | 2 points | 3 points |
|---|---|---|---|
| ≤3 yr | ≤34 | 35–39 | ≥40 |
| 4–5 yr | ≤30 | 31–35 | ≥36 |
| 6–12 yr | ≤26 | 27–30 | ≥31 |
| >12 yr | ≤23 | 24–27 | ≥28 |
Clinical signs (1 / 2 / 3 each):
- Oxygen: >95% RA / 90–95% RA / <90% or any supplemental O₂
- Auscultation: normal–end-expiratory wheeze / expiratory wheeze / insp+exp wheeze to diminished
- Retractions: none–intercostal / intercostal+substernal / +supraclavicular
- Dyspnea/speech: sentences (coos/babbles) / partial sentences (short cry) / single words (grunts)
Each contributes one point band, so the minimum is 5 and the maximum 15. RR is counted once (via the age band) — not double-counted as a raw rate.
Interpretation bands
- 5–7 — Mild (peak flow >70% predicted)
- 8–11 — Moderate (50–70%)
- 12–15 — Severe (<50%)
When to use it
At triage and after each bronchodilator treatment in a child with an acute exacerbation, to standardise severity grading and track response over time.
Worked example
A 7-year-old, RR 32 (6–12 band, ≥31 → 3), SpO₂ 92% on room air (2), expiratory wheeze (2), intercostal + substernal retractions (2), speaking in partial sentences (2).
Total = 3 + 2 + 2 + 2 + 2 = 11/15 → Moderate. Treat and re-score after bronchodilators.
Pitfalls
- Not the appendicitis PAS — same acronym, unrelated tool.
- Use the correct age band for RR; a normal-looking rate is age-dependent.
- Reassess after each treatment — a single score is a snapshot; the trend drives disposition.
- A reassuring score does not override a tiring child or rising CO₂; clinical gestalt and gas exchange win.
Run it: Pediatric Asthma Score (PAS)
Decision support for qualified clinicians only — verify against current primary guidelines and your clinical judgement.