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Diagnostic accuracy of PAT-POPS and ManChEWS for admissions of children from the emergency department
  1. Sarah Cotterill1,
  2. Andrew G Rowland2,3,
  3. Jacqueline Kelly2,
  4. Helen Lees2,
  5. Mohammed Kamara2
  1. 1Centre for Biostatistics, University of Manchester, Manchester, UK
  2. 2Emergency Department, North Manchester General Hospital, Manchester, UK
  3. 3The University of Salford, Salford, UK
  1. Correspondence to Dr Sarah Cotterill, Research Fellow, Centre for Biostatistics, Jean McFarlane Building, University of Manchester, Oxford Road, Manchester, M13 9PL, UK; sarah.cotterill{at}


Background The Pennine Acute Trust (PAT) Paediatric Observation Priority Score (PAT-POPS) is a specific emergency department (ED) physiological and observational aggregate scoring system, with scores of 0–18. A higher score indicates greater likelihood of admission. The Manchester Children's Early Warning System (ManChEWS) assesses six physiological observations to create a trigger score, classified as Green, Amber or Red.

Methods Prospectively collected data were used to calculate PAT-POPS and ManChEWS on 2068 patients aged under 16 years (mean 5.6 years, SD 4.6) presenting over 1 month to a UK District General Hospital Paediatric ED. Receiver operating characteristics (ROC) comparison, using STATA V.13, was used to investigate the ability of ManChEWS and PAT-POPS to predict admission to hospital within 72 h of presentation to the ED.

Results Comparison of the area under the ROC curve indicates that the ManChEWS ROC is 0.67 (95% CI 0.64 to 0.70) and the PAT-POPS ROC is 0.72 (95% CI 0.68 to 0.75). The difference is statistically significant. At a PAT-POPS cut-off of ≥2, 80% of patients had their admission risk correctly classified (positive likelihood ratio 3.40, 95% CI 2.90 to 3.98) whereas for ManChEWS with a cut off of ≥Amber only 71% of patients were correctly classified (positive likelihood ratio 2.18, 95% CI 1.94 to 2.45).

Conclusions PAT-POPS is a more accurate predictor of admission risk than ManChEWS. Replacing ManChEWS with PAT-POPS would appear to be clinically appropriate in a paediatric ED. This needs validation in a multicentre study.

  • paediatrics, paediatric emergency medicine
  • assessment
  • emergency department
  • hospitalisations
  • paediatric emergency med

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  • Twitter Follow Sarah Cotterill at @cotterillsarah1 and Andrew Rowland at @DrAndrewRowland

  • Contributors SC wrote the first draft, undertook the statistical analysis, finalised the manuscript and revised the paper in response to reviewer comments. AGR conceived and led the research project, had substantial input into the writing, and revised the paper in response to reviewer comments. JK co-led the data collection, reviewed the draft manuscript and had substantial input into database design and data entry. HL co-led the data collection, reviewed the draft manuscript and had substantial input into database design and data entry. MK facilitated the literature search, contributed to data entry and reviewed the draft manuscript.

  • Funding Pennine Acute Hospitals NHS Trust Endowment funds covered some of the costs of this study.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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