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Needlestick Risk Score

Aid to help decide on the use of postexposure prophylaxis for HIV exposure. (CJEM Jan 2003, Vertesi, RCH). Contributed by Dr. David Page.

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<p class="title">
	Risk Assessment Stratification Protocol (RASP)
</p>
<p class="normal text">
	Aid to help decide on the use of postexposure prophylaxis for HIV exposure. (CJEM Jan 2003, Vertesi, RCH)
</p>

<div name="demographics">
<table width="50%">
	<tr>
		<td class="heading1" width=25%>Patient name</td>
		<td class="formtext"><input class="formtext" name="PatientName" type="text" oscarDB=patient_name>
	</tr>
	<tr>
		<td class="heading1">Date:</td>
		<td class="formtext"><input class="formtext" name="TodaysDate" type="text" oscarDB=today>
	</tr>
        <tr>
		<td class="heading1">Patients age:</td>
		<td class="formtext"><input class="formtext" name="TodaysDate" type="text" oscarDB=age>
	</tr>
</table>
</div>

<br>

<div name="Questionnaire">
<table width="50%">
         <tr>
		<td class="heading1" width=60%>A: Identify source population:</td>
		
                <td class="heading1" width=20%>Score</td>
                <td class="heading1" width=20%></td>
		 
		
	</tr>

	
       
        <tr class="even">
		<td class="question"><p class="normal">Known HIV carrier: With acute AIDS illness </p></td>
		
                <td class="answer"><p class="normal">1</p></td>
                <td class="answer"><input type="radio" name="Q1" value="1"></td>
		
	</tr>
   
        <tr class="even">
		<td class="question"><p class="normal">Known HIV carrier: Asymptomatic </p></td>
		
                <td class="answer"><p class="normal">10</p></td>
                <td class="answer"><input type="radio" name="Q1" value="10"></td>
		
	</tr>

        <tr class="even">
		<td class="question"><p class="normal">Unknown HIV status: High-risk situation </p></td>
		
                <td class="answer"><p class="normal">100</p></td>
                <td class="answer"><input type="radio" name="Q1" value="100"></td>
		
	</tr>

        <tr class="even">
		<td class="question"><p class="normal">Unknown HIV status: Low-risk situation </p></td>
		
                <td class="answer"><p class="normal">1000</p></td>
                <td class="answer"><input type="radio" name="Q1" value="1000"></td>
		
	</tr>
	


       <tr>
		<td class="heading1" width=60%>B: Identify inoculum type:</td>
		
                <td class="heading1" width=20%>Score</td>
                <td class="heading1" width=20%></td>
		 
		
	</tr>

	
       
        <tr class="even">
		<td class="question"><p class="normal">Fresh blood</p></td>
		
                <td class="answer"><p class="normal">1</p></td>
                <td class="answer"><input type="radio" name="Q2" value="1"></td>
		
	</tr>
   
        <tr class="even">
		<td class="question"><p class="normal">Body fluids at risk(e.g. semen) </p></td>
		
                <td class="answer"><p class="normal">10</p></td>
                <td class="answer"><input type="radio" name="Q2" value="10"></td>
		
	</tr>

        <tr class="even">
		<td class="question"><p class="normal">Dried old blood </p></td>
		
                <td class="answer"><p class="normal">100</p></td>
                <td class="answer"><input type="radio" name="Q2" value="100"></td>
		
	</tr>

        <tr class="even">
		<td class="question"><p class="normal">Low risk secretions(tears, saliva, urine) </p></td>
		
                <td class="answer"><p class="normal">1000</p></td>
                <td class="answer"><input type="radio" name="Q2" value="1000"></td>
		
	</tr>





        
       <tr>
		<td class="heading1" width=60%>C: Identify method of transmission:</td>
		
                <td class="heading1" width=20%>Score</td>
                <td class="heading1" width=20%></td>
		 
		
	</tr>

	
       <tr class="even">
		<td class="question"><p class="normal">Intravenous </p></td>
		
                <td class="answer"><p class="normal">1</p></td>
                <td class="answer"><input type="radio" name="Q3" value="1"></td>
		
	</tr>
   
        <tr class="even">
		<td class="question"><p class="normal">Deep intramuscular </p></td>
		
                <td class="answer"><p class="normal">10</p></td>
                <td class="answer"><input type="radio" name="Q3" value="10"></td>
		
	</tr>

        <tr class="even">
		<td class="question"><p class="normal">Deep transcutaneous with visible bleeding at site </p></td>
		
                <td class="answer"><p class="normal">100</p></td>
                <td class="answer"><input type="radio" name="Q3" value="100"></td>
		
	</tr>

        <tr class="even">
		<td class="question"><p class="normal">Superficial transcutaneous with no visible bleeding </p></td>
		
                <td class="answer"><p class="normal">200</p></td>
                <td class="answer"><input type="radio" name="Q3" value="200"></td>
		
	</tr>

         <tr class="even">
		<td class="question"><p class="normal">Mucosal contact only </p></td>
		
                <td class="answer"><p class="normal">500</p></td>
                <td class="answer"><input type="radio" name="Q3" value="500"></td>
		
	 </tr>

          <tr class="even">
		<td class="question"><p class="normal">Intact skin </p></td>
		
                <td class="answer"><p class="normal">1000</p></td>
                <td class="answer"><input type="radio" name="Q3" value="1000"></td>
		
	 </tr>





          <tr>
		<td class="heading1" width=60%>D: Estimate volume of inoculum:</td>
		
                <td class="heading1" width=20%>Modifier</td>
                <td class="heading1" width=20%></td>
		 
		
	</tr>

	
       <tr class="even">
		<td class="question"><p class="normal">Massive (e.g. transfusion) </p></td>
		
                <td class="answer"><p class="normal">100</p></td>
                <td class="answer"><input type="radio" name="Q4" value="100"></td>
		
	</tr>
   
        <tr class="even">
		<td class="question"><p class="normal">Measurable (> 1ml) </p></td>
		
                <td class="answer"><p class="normal">10</p></td>
                <td class="answer"><input type="radio" name="Q4" value="10"></td>
		
	</tr>

        <tr class="even">
		<td class="question"><p class="normal">Moderate (large-bore hollow needle > 22g) </p></td>
		
                <td class="answer"><p class="normal">5</p></td>
                <td class="answer"><input type="radio" name="Q4" value="5"></td>
		
	</tr>

        <tr class="even">
		<td class="question"><p class="normal">Small (small-bore hollow needle < 22g) </p></td>
		
                <td class="answer"><p class="normal">3</p></td>
                <td class="answer"><input type="radio" name="Q4" value="3"></td>
		
	</tr>

         <tr class="even">
		<td class="question"><p class="normal">Trace surface only (e.g. suture needle) </p></td>
		
                <td class="answer"><p class="normal">1</p></td>
                <td class="answer"><input type="radio" name="Q4" value="1"></td>
		
	 </tr>

        
         
</table>
<br>
<table>
<tr>      
        <td>Total risk = D/ A x B x C </td>

</tr>
<tr>
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	<td>1/<input type="text" name="Score" size="10" value=""></td>
</tr> 

</table>

</div>


<br>
<br>



<div name="Application" class="DoNotPrint">
<table width=50%>

<tr>
	<td class="heading1" colspan="2">Recommendations</td>
</tr>
<tr>
	<td class="heading1" >Risk level</td>
	<td class="heading1" >Suggested treatment</td>
</tr>

<tr id="high">
	
	<td> > 1/1000</td>
	<td>  Definitely indicated  </td>
</tr>
 


<tr id="medium">
	
	<td> 1/1000 - 1/10 000</td>
	<td>  Recommended but optional  </td>
</tr>

<tr id="low">
	
	<td> 1/10 001 - 1/100 000</td>
	<td>  Optional but not recommended  </td>
</tr>

<tr id="very low">
	
	<td> < 1/100 000</td>
	<td> Not indicated  </td>
</tr>
</table>

<br>
<br>





<div name="Application" class="DoNotPrint">
<table width=60%>

<tr>
	<td class="heading1" colspan="2">Comparison risks in everyday life</td>
</tr>
<tr>
	<td class="heading1" width="80%">Specific causes of death in the next 12 months</td>
	<td class="heading1" width="20%"> Risk</td>
</tr>


<tr id="high1">
	<td colspan="2">
		<table width="100%">
			<tr>
				<td width="80%">Risk of being diagnosed with lung cancer in the next 12 months if you are (or were) a smoker</td>
				<td width="20%">1/250 </td>
			</tr>
			<tr>
				<td width="80%">Risk of having a heart attack in the next 12 months if you are over the age of 35 yrs.</td>
				<td width="20%">1/77</td>
			</tr>
		</table>
	</td>	
</tr> 
       

<tr id="medium1">
	<td colspan="2">
		<table width="100%">
			<tr>
				<td width="80%">Risk of dying in next 12 months while jogging (ave 2hr per week)</td>
				<td width="20%">1/10 000  </td>
			</tr>
			<tr>
				<td width="80%">Risk of dying in next 12 months in a road accident</td>
				<td width="20%">1/6 000</td>
			</tr>
		</table>
	</td>
</tr>

<tr id="low1">
	<td colspan="2">
		<table width="100%">
			<tr>
				<td width="80%">Risk of dying in next 12 months as a pedestrian hit by a car or truck</td>
				<td width="20%">1/40 000</td>
			</tr>
			<tr>
				<td width="80%">Risk of dying in next 12 months in a work related accident (office worker)</td>
				<td width="20%">1/37 000  </td>
			</tr>
			<tr>
				<td width="80%">Risk of dying in next 12 months by being murdered</td>
				<td width="20%">1/11 000  </td>
			</tr>
		</table>
	</td>
</tr>

<tr id="very low1">
	<td colspan="2">
		<table width="100%">
			<tr>
				<td width="80%"> Risk of dying in next 12 months by choking to death on food</td>
				<td width="20%"> 1/160 000  </td>
			</tr>
			<tr>
				<td width="80%"> Risk of dying in next 12 months from a previously unknown allergy to a prescribed drug</td>
				<td width="20%"> 1/1 000 000</td>
			</tr>
			<tr>
				<td width="80%"> Risk of dying in next 12 months from a lightening strike</td>
				<td width="20%"> 1/2 000 000  </td>
			</tr>
		</table>
	</td>
</tr>
</table>

<br>
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<br>
<br>

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