Kw. Monroe et al., USE OF PRISM SCORES IN TRIAGE OF PEDIATRIC-PATIENTS WITH DIABETIC-KETOACIDOSIS, American journal of managed care, 3(2), 1997, pp. 253-258
Citations number
9
Categorie Soggetti
Heath Policy & Services","Medicine, General & Internal
Triage guidelines are needed to help in the decision process of intens
ive care unit (ICU) versus non-ICU admission for patients with diabeti
c ketoacidosis (DKA). Pediatric risk of mortality (PRISM) scores have
long been used to assess mortality risk. This study assesses the usefu
lness of the traditional PRISM score and an adaptation of that score (
PRISM-ED, which uses presentation data only) in predicting hospital st
ay in pediatric patients with DKA. PRISM and PRISM-ED were tested for
correlation with length of stay and length of ICU stay. A medical reco
rd review was conducted for patients admitted to The Children's Hospit
al of Alabama with DKA during an 18-month period (n : 79). Two scores
were calculated for each study entrant: PRISM using the worst recorded
values over the first 24 hours and PRISM-ED using arrival values. Med
ian scores, median test, and Spearman rank correlations were determine
d for both tests. Median PRISM scores were PRISM 11 and PRISM-ED 12; M
edian PRISM and PRISM-ED scores for patients admitted to the ICU were
less than median scores among floor-admitted patients: [GRAPHICS] Spea
rman rank correlations were significant for both scores versus total s
tay: PRISM, rs 0.29; P 0.009; PRISM-ED, rs 0.60, P < 0.001. Also, corr
elations were significant for both scores versus ICU stay: PRISM rs 0.
22, P 0.05; PRISM-ED, rs 0.41, P < 0.001. Triage guidelines for ICU ve
rsus floor admission for DKA patients could have significant economic
impact (mean ICU charge : $11,417; mean charge for floor admission : $
4,447). PRISM Scores may be an important variable to include in a mult
iple regression model used to predict the need for ICU monitoring.