The Pediatric Risk of Admission (PRISA) Score

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