Pediatric Asthma Score (PAS)

PAS assigns 0-3 points across five domains for a total score from 0-15: respiratory rate (age-adjusted), oxygen saturation, auscultation, retractions, and dyspnea. Higher scores indicate more severe respiratory distress.

Which PAS is this? This page uses the 0–15 version that scores each domain from 0 to 3 (as in the Stony Brook scoring sheet in the references). Many hospitals, including Cincinnati Children's, use the original version from Kelly 2000 (Children's Hospital of The King's Daughters), which scores each domain from 1 to 3 for a total of 5 to 15 with different severity bands. The two totals are not interchangeable, so use the version your unit's pathway is built on.

• Use room air oxygen saturation when safe; if oxygen cannot be removed, score as requiring supplemental oxygen.
• Score dyspnea based on the child's best observed speech or cry while resting.
• Repeat the score after therapy to trend response over time.

1. Confirm age band and baseline oxygen support status before scoring.
2. Score all PAS components from the current bedside exam and vitals.
3. Pair PAS result with trajectory and response to bronchodilator/steroid interventions.
4. Define next action (continue protocol tier, escalate respiratory support, or consider higher-acuity care).
5. Document score components and reassessment interval for cross-shift consistency.

Respiratory rate scoring uses age-specific cut points. Count for a full minute and compare to the band below.

• Age 2-3 years: 0 points 18-26, 1 point 27-34, 2 points 35-39, 3 points 40 or higher.
• Age 4-5 years: 0 points 16-24, 1 point 25-30, 2 points 31-35, 3 points 36 or higher.
• Age 6-12 years: 0 points 14-20, 1 point 21-26, 2 points 27-30, 3 points 31 or higher.
• Age over 12 years: 0 points 12-18, 1 point 19-23, 2 points 24-27, 3 points 28 or higher.

• 0-4 (Mild): consider outpatient management with bronchodilator therapy and close follow-up.
• 5-8 (Moderate): typically requires frequent bronchodilators, systemic steroids, and observation.
• 9-12 (Severe): escalate therapy, monitor closely, and consider higher-acuity care.
• 13-15 (Very severe): high risk for respiratory failure; activate escalation pathways immediately.

Thresholds and interventions vary by institution. Use PAS to standardize communication and track response to therapy.

• Silent chest, severe fatigue, or declining mental status.
• Persistent hypoxia despite oxygen, cyanosis, or rising CO2.
• Marked accessory muscle use, impending exhaustion, or inability to speak.
• Hemodynamic instability or poor perfusion.

• After bronchodilator or escalation step: repeat PAS in the same treatment block.
• If improving and stable: continue interval scoring per institutional asthma pathway.
• If persistent distress or deterioration: immediate re-score and escalation.

• Current PAS total and component drivers (RR, SpO2/oxygen need, auscultation, retractions, dyspnea).
• Interventions delivered and timing of last treatment.
• Trajectory versus prior score(s) and clinical response.
• Next reassessment time and trigger threshold for escalation.

• Wang score bronchiolitis calculator
• Oxygenation Index (OI)
• Pediatric Vital Signs
• Pediatric respiratory rate chart by age
• Westley Croup Score
• Pediatric ED calculators hub

• Stony Brook Medicine. Pediatric Asthma Score (PAS) scoring factors.
• NAEPP 2020 Focused Updates to the Asthma Management Guidelines.
• Kelly CS, Andersen CL, Pestian JP, et al. Improved outcomes for hospitalized asthmatic children using a clinical pathway. Ann Allergy Asthma Immunol. 2000;84(5):509-516.