Refining and testing the diagnostic accuracy of an assessment tool (PAT-POPS) to predict admission and discharge of children and young people who attend an emergency department: protocol for an observational study

Abstract

BackgroundIncreasing attendances by children (aged 0–16 years) to United Kingdom Emergency Departments (EDs) challenges patient safety within the National Health Service (NHS) with health professionals required to make complex judgements on whether children attending urgent and emergency care services can be sent home safely or require admission. Health regulation bodies have recommended that an early identification systems should be developed to recognise children developing critical illnesses. The Pennine Acute Hospitals NHS Trust Paediatric Observation Priority Score (PAT-POPS) was developed as an ED-specific tool for this purpose. This study aims to revise and improve the existing tool and determine its utility in determining safe admission and discharge decision making.Methods/designAn observational study to improve diagnostic accuracy using data from children and young people attending the ED and Urgent Care Centre (UCC) at three hospitals over a 12 month period. The data being collected is part of routine practice; therefore opt-out methods of consent will be used. The reference standard is admission or discharge. A revised PAT-POPs scoring tool will be developed using clinically guided logistic regression models to explore which components best predict hospital admission and safe discharge. Suitable cut-points for safe admission and discharge will be established using sensitivity and specificity as judged by an expert consensus meeting. The diagnostic accuracy of the revised tool will be assessed, and it will be compared to the former version of PAT-POPS using ROC analysis.DiscussionThis new predictive tool will aid discharge and admission decision-making in relation to children and young people in hospital urgent and emergency care facilities.Trial registrationNIHR RfPB Grant: PB-PG-0815-20034.ClinicalTrials.gov: 213469. Retrospectively registered on 11 April 2018.

Pediatric Observational Priority Score and Early Warning Scoring System to Predict Admission Status in Pediatric Patients in Haji Adam Malik General Hospital

“…Appropriate assessment of admission likelihood in emergency department can reduce over admission and under admission in patients [11]. Inappropriate admission would increase costs and possibility of hospital acquiring complications in patients, whereas under admission could result in delayed medical care as well as morbidity and mortality [10], [12]. Over the past decade, several methods have been used to assess the likelihood of admission for pediatric patients in the emergency department with various results.…”

Observational cohort study with internal and external validation of a predictive tool for identification of children in need of hospital admission from the emergency department: the Paediatric Admission Guidance in the Emergency Department (PAGE) score

“…A published protocol is available 11 and only the core components of the methods are summarised in this paper. In this paper, 'participant' means a patient recruited into the study at one of the study sites.…”

Pediatric emergency triage systems

“…Abnormality in PAT is an independent risk factor for hospital admission and length of stay. Riaz et al 40 conducted an observational study in three hospitals for 12 months in 16,000 patients to assess the accuracy of the POPS, using hospital admission and safe discharge as predictors. The authors concluded that the POPS was an easy tool to implement, and it did not require additional infrastructure.…”