PRISM III Score Calculator

Description

The PRISM III score is an improved version of the PRISM score developed at the Children's National Medical Center in Washington, DC based on data collected at 32 pediatric intensive care units using 11,165 admissions.

Age Group	Age Range
neonate	0 to < 1 month
infant	1to 12 months
child	> 12 to 144 months (12 years)
adolescent	> 144 months (> 12 years)

Subscores:

(1) cardiovascular and neurologic vital signs: 5 measures

(2) acid-base and blood gas: 5 measures

(3) chemistry tests: 4 measures

(4) hematology tests: 3 measures (with PT and PTT counted as one)

Grading variables: Use the highest and/or lowest values for scoring.

Cardiovascular and Neurologic Vital Signs	Findings	Points
systolic blood pressure	neonate AND > 55 mm Hg	0
	neonate AND 40 -55 mm Hg	3
	neonate AND < 40 mm Hg	7
	infant AND > 65 mm Hg	0
	infant AND 45 -65 mm Hg	3
	infant AND < 45 mm Hg	7
	child AND > 75 mm Hg	0
	child AND 55 -75 mm Hg	3
	child AND < 55 mm Hg	7
	adolescent AND > 85 mm Hg	0
	adolescent AND 65 -85 mm Hg	3
	adolescent AND < 65 mm Hg	7
heart rate	neonate AND < 215 beats/minute	0
	neonate AND 215 - 225 bpm	3
	neonate AND > 225 beats/minute	4
	infant AND < 215 beats/minute	0
	infant AND 215 - 225 bpm	3
	infant AND > 225 beats/minute	4
	child AND < 185 beats/minute	0
	child AND 185 - 205 bpm	3
	child AND > 205 beats/minute	4
	adolescent AND < 145 beats/minute	0
	adolescent AND 145 - 155 bpm	3
	adolescent AND > 155 beats/minute	4
temperature	< 33°C	3
	33 - 40°C	0
	> 40°C	3
mental status	Glasgow coma score >= 8	0
	Glasgow coma score < 8	5
pupillary response	both reactive	0
	1 reactive AND (1 fixed AND > 3 mm)	7
	both fixed AND both > 3 mm	11

where:

• The heart rate should not be monitored during crying or iatrogenic agitation.

• Pupillary size should not be assessed after iatrogenic dilatation.

• Body temperature may be rectal, oral, axillary or blood.

• Mental status should not be scored within 2 hours of sedation, paralysis or anesthesia. If sedation, paralysis or anesthesia is continuous, score based status prior to sedation, paralysis or anesthesia.

Acid-Base and Blood Gases	Findings	Points
acidosis	pH > 7.28 AND total CO2 >= 17 mEq/L	0
	(pH 7.0 - 7.28) OR (total CO2 5 - 16.9 mEq/L)	2
	pH < 7.0 OR total CO2 < 5	6
pH	< 7.48	0
	7.48 - 7.55	2
	> 7.55	3
PCO2	< 50 mm Hg	0
	50 - 75 mm Hg	1
	> 75 mm Hg	3
total CO2	<= 34 mEq/L	0
	> 34 mEq/L	4
PaO2	>= 50 mm Hg	0
	42.0 - 49.9 mm Hg	3
	< 42 mm Hg	6

where:

• PaO2 requires arterial blood.

• PCO2 can be measured from arterial, venous or capillary specimens.

Chemistry Tests	Findings	Points
glucose	<= 200 mg/dL	0
	> 200 mg/dL	2
potassium	<= 6.9 mEq/L	0
	> 6.9 mEq/L	3
creatinine	neonate AND <= 0.85 mg/dL	0
	neonate AND > 0.85 mg/dL	2
	infant AND <= 0.90 mg/dL	0
	infant AND > 0.90 mg/dL	2
	child AND <= 0.90 mg/dL	0
	child AND > 0.90 mg/dL	2
	adolescent AND <= 1.30mg/dL	0
	adolescent AND > 1.30 mg/dL	2
BUN	neonate AND <= 11.9 mg/dL	0
	neonate AND > 11.9 mg/dL	3
	not neonate AND <= 14.9 mg/dL	0
	not neonate AND > 14.9 mg/dL	3

where:

• Whole blood measurements for glucose are increased 10% over serum; for potassium 0.4 mEq/L.

Hematologic Tests	Findings	Points
white blood cell count	>= 3,000 per µL	0
	< 3,000 per µL	4
platelet count	> 200,000 per µL	0
	100,000 - 200,000 per µL	2
	50,000 - 99,999 per µL	4
	< 50,000 per µL	5
PT and PTT	neonate AND PT <= 22 seconds AND PTT <= 85 seconds	0
	neonate AND (PT > 22 seconds OR neonate and PTT > 85 seconds)	3
	not neonate AND PT <= 22 seconds AND PTT <= 57 seconds	0
	not neonate AND (PT > 22 seconds OR PTT > 57 seconds)	3

where:

• The upper limit of the normal reference ranges for PT and PTT are not given.

Description

Specialty

Objective

ICD-10

Purpose: To use the PRISM III score to evaluate a pediatric patient receiving intensive care.

Description

Specialty

Objective

ICD-10