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Prediction of Pediatric Patient Admission/Discharge in the Emergency Department: Irish Pediatric Early Warning Score,
Colm Hannon1, Damian Roland, Ronan O'Sullivan2
1From the School of Medicine, University College Cork, Cork, Ireland.
Insights
The Paediatric Observation Priority Score (POPS) more accurately predicts emergency department admissions than the Irish Paediatric Early Warning Score (PEWS) and Irish Children
Area of Science:
- Pediatric Emergency Medicine
- Clinical Decision Support Systems
- Patient Triage
Background:
- Emergency departments (EDs) utilize various scoring systems to predict patient disposition.
- Accurate prediction of admission versus discharge is crucial for efficient ED resource allocation.
- The Irish Paediatric Early Warning Score (PEWS), Paediatric Observation Priority Score (POPS), and Irish Children's Triage System (ICTS) are used in pediatric care.
Purpose of the Study:
- To compare the predictive accuracy of PEWS, POPS, and ICTS for patient disposition in a pediatric emergency department.
- To determine which scoring system best predicts admission or discharge from the ED.
Main Methods:
- Prospective data collection of pediatric patients (<16 years) in an Irish mixed ED.
- Calculation of PEWS, POPS, and ICTS for each patient.
- Analysis using receiver operating characteristic (ROC) curves to compare predictive abilities.
Main Results:
- The Paediatric Observation Priority Score (POPS) demonstrated the highest accuracy with an area under the ROC curve of 0.7 (95% CI, 0.65-0.75).
- The Irish Paediatric Early Warning Score (PEWS) and Irish Children's Triage System (ICTS) showed lower predictive accuracy (AUC 0.58 for both).
- POPS outperformed PEWS and ICTS in predicting ED admission or discharge.
Conclusions:
- POPS exhibits superior accuracy in predicting ED admission compared to PEWS and ICTS.
- Implementing POPS as a cognitive aid in pediatric EDs for admission decisions is recommended.
- Further multicenter validation of POPS in Ireland is warranted.
Objective:
The aim of this study was to evaluate the ability of the Irish Paediatric Early Warning Score (PEWS), the Paediatric Observation Priority Score (POPS), and the Irish Children's Triage System (ICTS) to predict patient disposition pathways in an emergency department (ED) setting.
Methods:
Data were prospectively collected on patients aged less than 16 years presenting to an Irish mixed adult/pediatric ED over 3 weeks during December 2018. After calculating a once-off PEWS, POPS, and ICTS, we investigated the ability of the scoring systems to predict admission or discharge from the ED. Primary comparison of the index tests was conducted using receiver operating characteristic (ROC) curves.
Results:
A total of 550 patients were included in this study. There were 114 admissions (20.7%) and 436 discharges (79.3%). The POPS had an area under the ROC curve of 0.7 [95% confidence interval (CI), 0.65-0.75]. The PEWS had an area under the ROC curve of 0.58 (95% CI, 0.53-0.64). The ICTS had an area under the ROC curve of 0.58 (95% CI, 0.53-0.63).
Conclusions:
The POPS has greater accuracy as a predictor of admission from the ED than PEWS and ICTS. Possible future implementation of POPS into pediatric EDs as a cognitive prompt before admission decision seems to be merited. Further multicenter validation in Ireland would be helpful.
