Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
BMC Pediatrics
Published in: BMC Pediatrics 1/2018

Open Access 01-12-2018 | Study protocol

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

Authors: Samah Riaz, Andrew Rowland, Steve Woby, Tony Long, Joan Livesley, Sarah Cotterill, Calvin Heal, Damian Roland

Published in: BMC Pediatrics | Issue 1/2018

Login to get access

Abstract

Background

Increasing 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/design

An 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.

Discussion

This 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 registration

NIHR RfPB Grant: PB-PG-0815-20034.
ClinicalTrials.gov: 213469. Retrospectively registered on 11 April 2018.
Literature
1.
2.
3.
Roland D, Shahzad MW, Davies F. The importance of currency in data trends. Arch Dis Child. 2013;568-569(2013):98.
4.
5.
Pearson GA, editor. Why children die: a pilot study 2006; England (south west, north east and west midlands), Wales and Northern Ireland. London: CEMACH; 2008.
6.
Tambe P, Sammons HM, Choonara I. Why do young children die in the UK? A comparison with Sweden. Arch Dis Child. 2015;100:928–31.CrossRef
7.
Roland D, Coats T. An early warning? Universal risk scoring in emergency medicine. Emerg Med J. 2011;28(4):263.CrossRef
8.
Roland D, McCaffery K, Davies F. Scoring systems in paediatric emergency care: panacea or paper exercise? J Paediatr Child Health. 2016;52(2):181–6.CrossRef
9.
Seiger N, Maconochie I, Oostenbrink R. Validity of different pediatric early warning scores in the emergency department. Pediatrics. 2013;132:1–10.CrossRef
10.
Bradman K, Maconochie I. Can paediatric early warning score be used as a triage tool in paediatric accident and emergency? Eur J Emerg Med. 2008;15(6):359–60.CrossRef
11.
Cotterill S, Rowland AG, Kelly J, et al. Diagnostic accuracy of PAT-POPS and ManChEWS for admissions of children from the emergency department. Emerg Med J. 2016;33:756–62.CrossRef
12.
Roland D, Lewis G, Fielding P, Hakim C, Watts A, Davies F. The Paediatric observation priority score: a system to aid detection of serious illness and assist in safe discharge. Open J Emerg Med. 2016;4(2):38–44.CrossRef
13.
Roland D, Lewis G, Davies F. Addition of a subjective nursing assessment improves specificity of a tool to predict admission of children to hospital from an emergency department. Pediatr Res. 2011;70:587.CrossRef
14.
Roland D, Davies F, Coats T. The Paediatric observation priority score (POPS): outcomes of 24000 patients. Arch Dis Child. 2014;99:A24.CrossRef
15.
16.
Challen K, Roland D. Early warning scores: a health warning. Emerg Med J. 2016;33:812–7.CrossRef
17.
Vellinga A, Cormican M, Hanahoe B, Bennett K, Murphy A. Opt-out as an acceptable method of obtaining consent in medical research: a short report. BMC Med Res Methodol. 2011;40:1–4.
18.
Leegon J, Jones I, Lanaghan K, Aronsky D. Predicting hospital admission in a pediatric emergency department using an artificial neural network. AMIA Annu Symp Proc. 2006;1004.
19.
Cameron A, Rodgers K, et al. A simple tool to predict admission at the time of triage. Emerg Med J. 2014;0:1–6.
20.
DeLong ER, DeLong DM, Clarke-Pearson DL. Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach. Biometrics. 1988;44:837–45.CrossRef
21.
Flahault A, Cadilhac M, Thomas G. Sample size calculation should be performed for design accuracy in diagnostic test studies. J Clin Epidemiol. 2005;58:859–62.CrossRef
22.
Harrell FE. Regression modeling strategies: with applications to linear models, logistic regression, and survival analysis. Berlin: Springer; 2001.
23.
Deeks JJ, Altman DG. Diagnostic tests 4: likelihood ratios. BMJ. 2004;329:168–9.CrossRef
24.
StataCorp. Stata Statistical Software: Release 15. College Station, TX: StataCorp LP; 2017.
25.
Woolfall K, Frith L, Dawson A, et al. Fifteen-minute consultation: an evidence-based approach to research without prior consent (deferred consent) in neonatal and paediatric critical care trials. Arch Dis Child Educ Pract. 2016;101:49–53.CrossRef
Metadata
Title
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
Authors
Samah Riaz
Andrew Rowland
Steve Woby
Tony Long
Joan Livesley
Sarah Cotterill
Calvin Heal
Damian Roland
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Pediatrics / Issue 1/2018
Electronic ISSN: 1471-2431
DOI
https://doi.org/10.1186/s12887-018-1268-7

Other articles of this Issue 1/2018

BMC Pediatrics 1/2018 Go to the issue

Study protocol

Discovering the sense of touch: protocol for a randomised controlled trial examining the efficacy of a somatosensory discrimination intervention for children with hemiplegic cerebral palsy

Case report

Streptococcus agalactiae meningoencephalitis associated with gastroesophageal reflux disease and chronic proton pump inhibitors use, in a 9 month-old infant: a case report

Research article

Are one-stop centres an appropriate model to deliver services to sexually abused children in urban Malawi?

Study protocol

Delivery strategies for malaria chemoprevention with monthly dihydroartemisinin-piperaquine for the post-discharge management of severe anaemia in children aged less than 5 years old in Malawi: a protocol for a cluster randomized trial

Research article

Elevated central venous pressure is associated with increased mortality in pediatric septic shock patients

Research article

Health-related quality of life of the parents of children hospitalized due to acute rotavirus infection: a cross-sectional study in Latvia