The diagnostic accuracy of PAT-POPS and ManChEWS for admissions of children from the Emergency Department

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 (mean 5.6 years, SD 4.6) presenting over one month to a UK District General Hospital Paediatric ED. ROC comparison, using STATA 13, was used to investigate the ability of ManChEWS and PAT-POPS to predict admission to hospital within 72 hours of presentation to the ED. Results Comparison of the area under the Receiver Operating Characteristics (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 2.90-3.98) 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 multi-centre study.