Performance of the combined models of Pediatric Risk of Admission scores I and II, and C-reactive protein for prediction of hospitalization in febrile children who visited the emergency department

Abstract

Purpose To study the performance of the combined models of Pediatric Risk of Admission (PRISA) scores I and II and C-reactive protein (CRP) for prediction of hospitalization in febrile children who visited the emergency department. Methods We reviewed febrile children aged 4 months - 17 years who visited a tertiary hospital emergency department between January and December 2017. White blood cell count, CRP concentration, the PRISA scores, and systemic inflammatory response syndrome score were calculated. We compared areas under the curves (AUCs) of the admission decision support tools for hospitalization using receiver operating characteristic curve analysis. Results Of 1,032 enrolled children, 423 (41.0%) were hospitalized. CRP and the PRISA scores were significantly higher in the hospitalization group than in the discharge group (all P < 0.001). Among the individual tools, CRP showed the highest AUC (0.69; 95% confidence interval [CI], 0.66-0.72). AUC was 0.71 (95% CI, 0.69-0.74) for the combined model of the PRISA I score and CRP, and 0.71 (95% CI, 0.68-0.74) for that of the PRISA II score and CRP. The AUC of PRISA score I and CRP combined was significantly higher than that of isolated CRP (P=0.048). Conclusion The combined model of the PRISA I score and CRP may be useful in predicting hospitalization of febrile children in emergency departments.

Keywords

• area under curve
• c-reactive protein
• decision support techniques
• fever
• patient admission