SPREADING INNOVATION IN CHILDREN'S EMERGENCY CARE: AN EXTERNAL PRAGMATIC VALIDATION OF THE PAEDIATRIC OBSERVATION PRIORITY SCORE

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Abstract

Objectives & Background

In paediatric emergency care the stakes are high: serious illness is uncommon but demand for urgent face-to-face medical assessment is increasing and there continue to be errors in the identification of seriously unwell children. Risk-averse strategies of referring all children of ‘potential concern’ for specialist paediatric assessment overloads an already stretched out of hours system, and leads to unnecessary hospital admissions.

Objectives & Background

Scoring systems, despite being beneficial at the centre of development, often have not been shown to implement well in other settings. In a study of 20000 patients using our locally developed Paediatric Observation Priority Score (POPS) it was found a POPS >4 correlated with admission for greater than 24 hours and no patients with a POPS of 0 had a serious bacterial illness.

Objectives & Background

The aim of this study was to examine the utility of POPS in Emergency Departments in the UK and determine baseline performance characteristics.

Methods

POPS was implemented in 4 emergency departments for children presenting between the ages of 0–16. Patients were managed as per local trust guidelines with POPS observations being taken prospectively at the first opportunity. Patient disposition was recorded, with participants being grouped into 4 categories: Discharged from ED, discharged but return within 7 days and admitted for less or more than 24 hours.

Results

3323 participants met inclusion/exclusion criteria with POPS scores ranging from 0 to 11 with a mean score 2.33 and standard deviation of 2.00.

Results

Combining data from all sites, there was a correlation between admission/discharge and POPS (R2=0.96) (figure 1). 90% of patients with a POPS 0 were discharged from the ED. 111 (3.3%) of patients re-presented. Odds ratio of readmission with POPS 5–9 against 0–4 was 2.05 (CI 1.20 to 3.52). Receiver operator curve for admission/discharge was 0.66 (CI 0.64 to 0.69).

Results

Using chi-squared models, admission/discharge for POPS 0–4 at each individual site showed no significant difference (p=0.93). However, for POPS >5 a significant difference was found (p<0.01).

Conclusion

It is feasible to implement POPS into Emergency Departments and have similar peformance characteristics to the original site of development. This 'second' knowledge translation gap is often challenging to overcome and there is now evidence to support a wider health service evaluation of POPS' impact.

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