USE OF PRISM SCORES IN TRIAGE OF PEDIATRIC-PATIENTS WITH DIABETIC-KETOACIDOSIS

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.