Pediatric risk of admission (PRISA): a measure of severity of illness for assessing the risk of hospitalization from the emergency department

J M Chamberlain, K M Patel, U E Ruttimann, M M Pollack
Annals of Emergency Medicine 1998, 32 (2): 161-9

STUDY OBJECTIVE: The development and validation of a pediatric emergency department severity of illness assessment method, using hospital admission as the primary outcome.

METHODS: A random sample of 25% of ED charts from 4 consecutive months in a university-affiliated pediatric hospital was reviewed, after exclusion of children with minor injuries and children triaged to the nonurgent clinic. Sampled data included components of the medical history, physical findings, physiologic variables, diagnoses, and ED therapies. Univariate and multivariate logistic regression analyses, with bootstrapping validation, were performed to develop a bias-corrected model estimating the probability of hospital admission.

RESULTS: Of the 2,683 ED patients whose records were reviewed, 643 (24%) were admitted to the hospital. The final model, which yielded a Pediatric Risk of Admission (PRISA) score, included the following: 3 components of the medical history, 3 chronic disease factors, 9 physiologic variables, 2 therapies, and 4 interaction terms. Overall, the number of hospital admissions was well predicted in both the 80% development and 20% validation samples. In the former, 514 admissions were predicted and 514 were observed; in the latter, 126.9 admissions were predicted and 129 were observed. The Hosmer-Lemeshow goodness-of-fit test demonstrated good agreement between observed and expected admissions in consecutive deciles of admission probability; total chi2 was 10.49 (P=.233) for the development sample and 11.85 (P=.222) for the validation sample. The areas under the receiver operating characteristic curves (+/-SE) were .86+/-.011 and .825+/-.024, respectively. As the risk of hospital admission increased, the proportions of patients using unique hospital-based resources and using ICU resources increased, and the proportion of patients dying increased.

CONCLUSION: The probability of admission to the hospital can reliably be estimated from data available during the pediatric ED stay. Applications for this method include studies of quality and efficiency of care and measurements of severity of illness.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Trending Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"