Diagnostic accuracy of PAT-POPS and ManChEWS for admissions of children from the emergency department

Cotterill, S; Rowland, A; Kelly, J; Lees, H; Kamara, M

Abstract

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.

Citation

Cotterill, S., Rowland, A., Kelly, J., Lees, H., & Kamara, M. (2016). Diagnostic accuracy of PAT-POPS and ManChEWS for admissions of children from the emergency department. Emergency Medicine Journal, 33(11), https://doi.org/10.1136/emermed-2015-204647

• Journal Article Type: Article
• Acceptance Date: Mar 14, 2016
• Online Publication Date: Apr 11, 2016
• Publication Date: Apr 11, 2016
• Deposit Date: May 11, 2016
• Publicly Available Date: Apr 26, 2019
• Journal: Emergency Medicine Journal
• Print ISSN: 1472-0205
• Electronic ISSN: 1472-0213
• Publisher: BMJ Publishing Group
• Volume: 33
• Issue: 11
• DOI: https://doi.org/10.1136/emermed-2015-204647
• Publisher URL: http://dx.doi.org/10.1136/emermed-2015-204647
• Related Public URLs: http://emj.bmj.com/