Calc Function

    • Calcs that help predict probability of a diseaseDiagnosis
    • Subcategory of 'Diagnosis' designed to be very sensitiveRule Out
    • Disease is diagnosed: prognosticate to guide treatmentPrognosis
    • Numerical inputs and outputsFormula
    • Med treatment and moreTreatment
    • Suggested protocolsAlgorithm





    Chief Complaint


    Organ System


    Patent Pending

    HIV Needle Stick Risk Assessment Stratification Protocol (RASP)

    Quantifies HIV exposure risk by source and exposure type and need for prophylaxis.
    When to Use
    Why Use
    • High vs low risk exposure; helps determine whether or not to start PEP.
    • Always try to test the source patient for HIV, and other infectious diseases such as Hepatitis C and Hepatitis B.

    The HIV Needle Stick Risk Assessment Protocol quantifies gives healthcare workers a more objective risk assessment of getting HIV after a needle stick.

    Known HIV+: acute AIDS illness*
    Known HIV+: asymptomatic HIV
    Unknown HIV status: high-risk situation**
    Unknown HIV status: low-risk situation
    Fresh blood
    Other high-risk fluids (ex: semen)
    Dried old blood
    Low-risk secretions (ex: tears, urine, saliva)
    Deep intramuscular
    Deep transcutaneous with visible bleeding
    Superficial transcutaneous without bleeding
    Mucosal contact only
    Intact skin
    Measurable (>1mL)
    Moderate (large-bore, hollow needle >22G)
    Small (small-bore, hollow needle)
    Trace (ex: suture needle)


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    Next Steps
    Creator Insights


    PEP should be started in conjunction with infectious disease consultation, as well as gathering information about the source patient and his or her medication regimen.


    Total risk = basic risk x volume of innoculum modifier

    Basic risk = 1 / (source modifier * innoculum type modifier * method of transmission modifier)

    Facts & Figures

    *End stage AIDS, hospitalized, high viral load

    **Suspected HIV, IV drug user, unknown needle with high local HIV prevalence

    The author also cites some every day life risks to help provide risk perspective:

    Risk of dying in the next 12 months
    Overall risk of dying in the next 12 months (all causes) 1/3,000
    Specific causes of death in the next 12 months
    From a lightning strike 1/2,000,000
    In an accident in your bathtub or shower 1/1,000,000
    From a previously unknown allergy to a prescribed drug 1/1,000,000
    By choking to death on food 1/160,000
    In a bicycle accident (if you own a bicycle) 1/130,000
    From toxic shock if you use tampons 1/100,000
    By drowning 1/50,000
    From a fire 1/50,000
    As a pedestrian hit by a car or truck 1/40,000
    In a work-related accident (office workers) 1/37,000
    From a fall 1/20,000
    In a work-related accident (overall) 1/11,000
    By being murdered 1/11,000
    While jogging (average 2 h/wk) 1/10,000
    In a road accident 1/6,000
    From any kind of accident 1/3,000
    Other risks
    Risk of dying on your next commercial jet flight 1/5,000,000
    Lifetime risk of being on a bridge when it collapses 1/4,000,000
    Risk of dying if you get influenza 1/5,000
    Risk of being diagnosed with cancer in the next 12 months (overall death rate 50%) 1/3,600
    Risk of being diagnosed with lung cancer in the next 12 months if you are (or were) a smoker (overall death rate about 90%) 1/250
    risk of having a heart attack in the next 12 months if you are over 35 years of age 1/77
    Dr. Les Vertesi

    About the Creator

    Les Vertesi, MD, is the executive director of British Columbia's Health Services Purchasing Organization and a part-time emergency room physician. He is on the faculty of Simon Fraser University's Institute for Health Research and Education and is associate director of Health Research with the Fraser Health Authority of British Columbia. Dr. Vertesi published a book in 2003:

    To view Dr. Les Vertesi's publications, visit PubMed

    About the Creator
    Dr. Les Vertesi