Abstract
Objectives and Background Scoring systems in Emergency Departments (EDs) are rarely validated. This study aimed to examine the Paediatric Observation Priority Score (POPS), a method of quantifying patient acuity, in EDs in the United Kingdom, and determine baseline performance characteristics. Methods POPS was implemented in 4 EDs for children (ages of 0 to 16) with participants grouped into 3 categories: discharged from ED, discharged but with return within 7 days, and admitted for less or more than 24 hours. Results 3323 participants with POPS scores ranging from 0 to 11 (mean = 2.33) were included. The proportion of each POPS score varied between sites with approximately 10–20% being POPS 0 and 12–25% POPS greater than 4. Odds ratio of readmission with POPS 5–9 against 0–4 was 2.05 (CI 1.20 to 3.52). POPS 0–4 showed no significant difference (p = 0.93) in relation to admission/discharge rates between sites with a significant difference found (p < 0.01) for POPS > 5. Conclusion It is feasible to implement POPS into EDs with similar performance characteristics to the original site of development. There is now evidence to support a wider health service evaluation to refine and improve the performance of POPS.
Highlights
In developed countries serious childhood illness is uncommon but increasing numbers of families seek urgent faceto-face medical assessment [1, 2] for minor illness, and there continue to be missed opportunities in staff identifying seriously ill children [3]
The objectives of the study were to describe the distribution of scores in Emergency Departments (EDs) outside our institution, confirm a threshold indicator of Paediatric Observation Priority Score (POPS) > 4 for hospital admission risk, and examine discharge and representation rates following uptake of POPS
The proportion of each POPS score varied between sites with approximately 10–20% being POPS 0 and 12–25% POPS greater than 4
Summary
In developed countries serious childhood illness is uncommon but increasing numbers of families seek urgent faceto-face medical assessment [1, 2] for minor illness, and there continue to be missed opportunities in staff identifying seriously ill children [3]. Risk-averse strategies of referring all children of “potential concern” for specialist paediatric assessment overload an already stretched out-of-hours system and lead to unnecessary hospital admissions. “scoring tools” exist most are ward-based “early warning scores (EWS)” which identify children needing high-level critical care. They are not validated for use early in illness [4], or through the range of childhood acute illness (mild to severe). Attempts to implement ward-based scoring systems have resulted in disappointing results [5, 6]
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