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THE PAEDIATRIC OBSERVATION PRIORITY SCORE (POPS): A USEFUL TOOL TO PREDICT LIKELIHOOD OF ADMISSION FROM THE EMERGENCY DEPARTMENT
  1. J Kelly1,
  2. A G Rowland1,
  3. S Cotterill2,
  4. H Lees1,
  5. M Kamara1
  1. 1Emergency Department, North Manchester General Hospital, Manchester, United Kingdom
  2. 2Centre for Biostatistics, Institution of Population Health, University of Manchester, Manchester, United Kingdom

Abstract

Objectives & Background No specific early warning score universally validated for use in all children presenting to the Emergency Department (ED) exists. POPS is a novel aggregate scoring system, designed for ED use.

Methods Prospectively collected physiological and observational data were used to calculate POPS on 2068 patients aged under 16 presenting over one month to a UK District General Hospital Paediatric ED. Logistic regression was used to investigate the effect of POPS at first presentation on admission to hospital within the subsequent 72 hours.

Results 46% of patients were diagnosed with trauma and 54% with a medical condition. Mean age was 5.6 years (SD 4.6). 15.3% were admitted on first presentation. 76 re-presented within 72 hours of discharge from the ED and 19.7% were admitted. The mean POPS on first presentation was 0.87 (SD 1.58) overall (medical patients 1.03 (SD 1.70), trauma patients 0.68 (SD 1.41), p<0.001). POPS had a statistically significant positive effect on admission. A one point increase in POPS was associated with a 70% increase in the odds ratio (OR) of admission (p<0.001), with an area under the ROC of 0.72 (medical patients OR 1.67, area under ROC 0.73, p<0.001; trauma patients OR 1.77, area under ROC 0.69, p<0.001). The sensitivity and specificity of POPS to predict admission likelihood were: POPS≥2 (sensitivity 50%, specificity 85%), POPS≥3 (sensitivity 36%, specificity 93%).

Conclusion POPS is a useful tool to predict the admission likelihood from the ED. POPS≥2 correctly predicts 50% of children who should be admitted and 85% of children who should be discharged. Multi-centre validation would help to refine POPS, increasing its sensitivity and specificity to admission likelihood, to improve the safety of discharge decisions and healthcare resource utilisation.

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