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Key messages What is already known on this subject?
There is a need for a specific emergency department early warning system for children.
Manchester Children's Early Warning System (ManChEWS) is one scoring system, which correctly identifies the deteriorating child, but can overtrigger which may lead staff to become immune to the score.
Paediatric Observation Priority Score (POPS) is a new scoring system, combining physiological measurement and clinical observation.
What might this study add?
A Pennine Acute Trust (PAT) Paediatric Observation Priority Score (PAT-POPS) score >=2 would correctly identify about 50% of children who need to be admitted from the ED, and a PAT-POPS score <2 would correctly identify 85% of cases who could be discharged from the ED.
PAT-POPS has slightly higher diagnostic accuracy for predicting the likelihood of admission than an existing tool often used in this population, ManChEWS.
PAT-POPS can be used for patients with either trauma or illness.
Introduction
Health professionals make judgements on whether children attending emergency departments (EDs) require hospitalisation, or can safely be sent home. These judgements require a complex assessment of the child's health and an estimation of the potential for improvement or deterioration. Since at least 2006 it has been recommended that early identification systems to recognise children developing critical illness should be used. 1 Many paediatric early warning scores (EWS) use track and trigger systems, relying on repeated observations over time, intended for use with hospitalised children, 2-9 to predict which children are likely to deteriorate, rather than who requires admission from an ED. There is a need for a specific ED early warning system, validated on ED patients. 10 In the absence of an ED EWS, our ED used The Royal Manchester Children's Hospital Early Warning System (ManChEWS), a track and trigger system. 11 Variation in six physiological parameters (RR, oxygen requirement, heart rate, systolic BP, capillary refill time and conscious level) is scored during routine nursing observations ( figure 1 ). While ManChEWS correctly identifies the deteriorating child it overtriggers which may lead staff to become immune to the score. 4
The Pennine Acute Trust (PAT) Paediatric Observation Priority Score (PAT-POPS) is a new EWS, designed for use in children's ED, combining physiological measurement and clinical observation into an aggregate scoring system ( figure...