Saptharishi et al developed the Pediatric Risk of Nosocomial Sepsis score for identifying healthcare-associated infections in the pediatric intensive care unit (ICU). The authors are from the Post-Graduate Institute of Medical Education & Research and MM Institute of Medical Sciences & Research in India.
Patient: pediatric patient in the ICU
Outcome: healthcare associated infections (HAI) including sepsis
Parameters:
(1) PRISM III-24 score (performed during the first 24 hours of ICU admission)
(2) indwelling catheters within the past 48 hours (excludes peripheral lines and endotracheal tube; includes central venous lines, arterial lines, PICC lines, urinary catheters, chest tubes)
(3) prior use of antibiotics (number of antibiotics used prior to the assessment)
(4) albumin infusion in the ICU
(5) age of the patient in years
(6) IVIG or steroids (immunomodulator use)
(7) intubation
|
Parameter
|
Finding
|
Points
|
|
PRISM III 24
|
5 to 15
|
0
|
|
|
16 to 26
|
2
|
|
|
27 to 37
|
4
|
|
|
38 to 48
|
7
|
|
|
49 to 59
|
9
|
|
indwelling catheters
|
no
|
0
|
|
|
yes
|
6
|
|
prior use of antibiotics
|
< 4
|
0
|
|
|
>= 4
|
2
|
|
albumin infusion
|
no
|
0
|
|
|
yes
|
5
|
|
age of the patient
|
<= 5 years
|
3
|
|
|
> 5 years
|
0
|
|
use of an immunomodulator
|
no
|
0
|
|
|
yes
|
6
|
|
intubation
|
no
|
0
|
|
|
yes
|
6
|
where:
• Albumin infusions would probably be uncommon in developed countries. Malnutrition with severe hypoalbuminemia could be an issue in the study population.
total score =
= SUM(points for all 7 items)
Interpretation:
• minimum score: 0
• maximum score: 37
• The higher the score the greater the risk of healthcare-associated sepsis.
• A score > 15 was high risk for healthcare associated sepsis.
Performance:
• Using a cutoff of 15 was associated with a sensitivity of 79% and specifity of 79% for healthcare associated infection.
