Objectives & Background Infants, especially those in the first month of life, are a very high risk group of attendees to Emergency Departments. Despite immunistaion programmes the incidence of serious bacterial illness in this group remains around 10%. Although in some cases the protocolised nature of fever management according to NICE guidance makes a physiological assessment less relevant (all children under 3 months with a fever>38.5 tend to get a full septic screen) increasing attendances to emergency and urgent care settings make early and correct decision making vitally important⇓.
Methods Nearly all patients attending our Children's Emergency Department have their vital signs assessed at triage or expediently with the Paediatric Observation Priority Score (POPS). POPS aggregates a combination of physiological characteristics, with observational components and specific domains of nurse gut feeling and past medical history (Figure 1). All infants less than 4 weeks old who presented over a two month period were included as part of a service evaluation of POPS. Data was recorded on POPS, disposition and outcome of any investigations pertaining to the diagnosis of a serious bacterial illness. The criteria for a serious bacterial illness was that defined by the RCPCH recognising acute illness in children working group.
Results 104 patients (less than 4 weeks) presenting to the Emergency Department had POPS scores, disposition and any investigations recorded. There were 3 patients with enterovirus meningitis (of which 1 had a coliform UTI) but no positive blood cultures. Results by POPS are in table 1. With a prevalance of serious bacterial illness at 3.8% the negative predictive value of POPS<4 was 100%.
Conclusion The POPS system applied at initial assessment maybe useful in recognising children who are not at risk of serious bacterial illness. However the lack of positive blood cultures in this sample means it is not definitively possible to demonstrate the utility of physiological and observational signs alone in assisting with decision making in neonates presenting to the ED i.e does a POPS 0 exclude serious bacterial illness? A national study evaluating the exclusion of sepsis in neonates would be a beneficial health service research project⇓.
- emergency departments
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