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Defining significant childhood illness and injury in the Emergency Department: a consensus of UK and Ireland expert opinion
  1. Peter J Lillitos1,2,
  2. Mark D Lyttle3,4,
  3. Damian Roland5,6,
  4. Colin VE Powell7,8,
  5. Julian Sandell9,
  6. Andrew G Rowland10,11,
  7. Susan M Chapman12,13,
  8. Ian K Maconochie2,14
  9. On behalf of PERUKI and GAPRUKI
  1. 1 Acute Receiving Unit, Royal Hospital for Sick Children, Edinburgh, UK
  2. 2 Department of Paediatric Emergency Medicine, Imperial College NHS Trust, London, UK
  3. 3 Paediatric Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
  4. 4 Academic Department of Emergency Care, University of the West of England, Bristol, UK
  5. 5 Department of Health Sciences, SAPPHIRE Group, University of Leicester, Leicester, UK
  6. 6 Children’s Emergency Department, Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
  7. 7 School of Medicine, Cardiff University, Cardiff, UK
  8. 8 Department of Emergency Medicine, Sidra Medicine, Doha, Al Rayyan, Qatar
  9. 9 Department of Paediatrics, Poole Hospital NHS Trust, Dorset, UK
  10. 10 The School of Health and Society, The University of Salford, Salford, UK
  11. 11 Emergency Department, North Manchester General Hospital, The Pennine Acute Hospitals NHS Trust, Manchester, UK
  12. 12 Gulf Regional Office, Great Ormond Street Hospital, London, UK
  13. 13 UCL Great Ormond Street Institute for Child Health, London, UK
  14. 14 Faculty of Medicine, Imperial College London, UK
  1. Correspondence to Dr Peter J Lillitos, Acute Receiving Unit, Royal Hospital for Sick Children, Edinburgh, EH91LF, UK ; plillitos{at}


Background Clarifying whether paediatric early warning scores (PEWS) accurately predict significant illness is a research priority for UK and Ireland paediatric emergency medicine (EM). However, a standardised list of significant conditions to benchmark these scores does not exist.

Objectives To establish standardised significant illness endpoints for use in determining the performance accuracy of PEWS and safety systems in emergency departments (ED), using a consensus of expert opinion in the UK and Ireland.

Design Between July 2017 and February 2018, three online Delphi rounds established a consensus on ‘significant’ clinical conditions, derived from a list of common childhood illness/injury ED presentations. Conditions warranting acute hospital admission in the opinion of the respondent were defined as ‘significant’, using a 5-point Likert scale. The consensus was a priori ≥80% (positive or negative). 258 clinical conditions were tested.

Participants and settings Eligible participants were consultants in acute or EM paediatrics, or adult EM, accessed via 53 PERUKI (Paediatric Emergency Research in the UK and Ireland)’s research collaborative sites, and 27 GAPRUKI (General and Adolescent Paediatric Research in the UK and Ireland)’s sites, 17 of which overlap with PERUKI.

Main outcome measures To create a list of conditions regarded as ‘significant’with ≥80% expert consensus.

Results 43 (68%) of 63 PERUKI and GAPRUKI sites responded; 295 experts were invited to participate. Participants in rounds 1, 2 and 3 were 223 (76%), 177 (60%) and 148 (50%), respectively; 154 conditions reached positive consensus as ‘significant’; 1 condition reached a negative consensus (uncomplicated Henoch-Schönlein purpura); and 37 conditions achieved non-consensus.

Conclusions A list of significant childhood conditions has been created using UK and Irish expert consensus, for research purposes, for the first time. This will be used as the benchmark endpoint list for future research into PEWS/safety systems performance in EDs.

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

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  • Contributors IKM: project supervisor, conceived the idea for the project; advised on the study design and contributed to the write up of the paper. PJL: project lead, responsible for designing the study and conducting the analysis; main author of the paper. MDL: responsible for disseminating the survey to the PERUKI and GAPRUKI network groups and site leads; advised in the study design and the analysis; contributed to the write up of the paper. CVP: involved in disseminating the survey to the GAPRUKI network; advised on the study design; contributed to the write up of the paper. DR, AGR, JS and SMC: advised on the study design and analysis; contributed to the write up of the paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Ethics approval No formal research ethical approval was required for this study as it was a survey of health professionals identified via established research networks. Participation was deemed as consent.

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

  • Data sharing statement There are no unpublished data from this study. Author PJ Lillitos is in possession of the raw data.

  • Correction notice This article has been updated since it was published online first. Supplementary file 2 has been updated.