Description

The Pediatric Risk of Admission (PRISA) Score is a measure of severity of illness for pediatric patients seen in the Emergency Department. The score was developed in Washington, DC (George Washington University and Children's National Medical Center).


Components and Findings:

(1) history: 3

(2) chronic disease states: 3

(3) physiologic findings: 9

(4) therapies received in the Emergency Department: 2

(5) adjustment for interactions between findings: 4

 

Component

Finding

Score

history

arrival by ambulance or helicopter

8

 

referral by physician or another ED

10

 

age < 29 days

9

chronic disease states

immunocompromised

9

 

dependence on medical device

10

 

asthma, taking medications in addition to bronchodilation

3

physiologic findings

abnormal mental status

8

 

elevated heart rate (> 160 in neonate, > 160 in infant, > 136 in child, > 111 in adolescent)

3

 

elevated respiratory rate  (> 59 in neonate, > 69 in infant, > 60 in child, > 30 in adolescent)

8

 

elevated diastolic blood pressure (> 60 in neonate, > 70 in infant, > 80 in child, > 86 in adolescent)

4

 

decreased systolic blood pressure (< 70 in neonate, < 90 in infant, < 100 in child, < 107 in adolescent)

3

 

decreased temperature (< 36.9°C in neonate, < 36.9°C in infant, < 36.2°C in child, < 36.1°C in adolescent)

8

 

elevated glucose (> 124 mg/dL)

10

 

elevated platelet count (> 449,000 per µL)

8

 

decreased hemoglobin (< 15 g/dL in neonate, < 9.0 g/dL in infant, < 9.3 g/dL in child, < 9.6 g/dL in adolescent)

12

emergency department therapies

isotonic fluid bolus

10

 

more than 4 nebulizations

18

interactions

low hemoglobin + referral from ED/physician

-13

 

low temperature + referral from ED/physician

-11

 

elevated platelets + isotonic fluid bolus

-14

 

abnormal mental status + isotonic fluid bolus

-6

(after Table 2, page 163, Chamberlain, which shows the adjusted odds ratios and 95% confidence intervals)

 

where:

• In Table 2, page 163, the decreased systolic pressure showed the relation sign as ">", but this seemed inconsistent with "decreased".

• neonates will be taken as 0-1 month of age, infants 1-24 months, child 2-12 years and adolescent 13-18 years

• I don't see high body temperature by itself as a criteria for admission, but this could be done indirectly from parenteral antibiotics or other treatments.

 

PRISA score =

= SUM(points for findings present)

 

odds ratio for admission =

= EXP((0.1507 * (PRISA score)) - 3.0718)

 

probability of admission =

= (odds ratio for admission) / (1 + (odds ratio for admission))

 

Interpretation:

• minimum PRISA score: 0

• maximum PRISA score: possibly 107

• A PRISA score >= 50 is associated with a 99+% probability of admission.

 

Criteria used for mandatory admission (probability of admission 1.0):

(1) parenteral antibiotics (> 1 dose)

(2) parenteral anticonvulsants

(3) parenteral anti-arrhythmic agents

(4) parenteral analgesics

(5) intravenous infusion of insulin

(6) parenteral inotropic agents

(7) intravenous bolus of potassium, calcium, magnesium or sodium bicarbonate

(8) intravenous fluids greater than maintenance requirements

(9) inspired oxygen greater than baseline

(10) nebulizations more frequently than every 3 hours

(11) airway suctioning

(12) endotracheal intubation

(13) mechanical ventilation or continuous airway pressure (CPAP)

(14) general or epidural anesthesia

(15) arterial or venous central line

(16) tube thoracostomy

(17) cardiopulmonary resuscitation

(18) nasogastric or orogastric tube

(19) cardiac catheterization

(20) transfusion of blood products

(21) nothing by mouth status (> 6 hours in neonate, > 8 hours in infant, > 12 hours in child, > 12 hours in adolescent)

(22) acute coma

(23) stroke

(24) absolute neutrophil count < 500 per µL

(25) platelet count < 20,000 per µL

(26) burns > 10% BSA or any third degree (full thickness) burns

(27) suicide precautions

(28) transfer to ICU care


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