Emergency Medical Services Clinician Accuracy Using the Pediatric Observation Priority Score

One barrier to including low-acuity children in alternative EMS disposition programs is a lack of triage tools to identify children at low risk of deterioration. The Pediatric Observation Priority Score (POPS) is a triage tool developed in the United Kingdom, incorporating vital signs, clinical observations, and medical history. Our objectives were to determine (1) whether US EMS clinicians can accurately assign a POPS in a controlled setting and (2) whether there is a difference in accuracy between paramedics and emergency medical technicians (EMTs).

We conducted an observational study with EMS clinicians. Participants were provided with an overview of the POPS and then reviewed 10 patient videos. Participants calculated a POPS for each case. Physicians with expertise in pediatric EMS and medical education independently assigned the reference POPS. We calculated the proportion of assigned POPS within 2 points of the reference score and compared the accuracy of paramedics and EMTs.

We recruited 50 participants (32% paramedics, 68% EMTs). The proportion of assigned POPS within 2 points of the reference was 0.99 (95% CI: 0.97-0.99), and for individual scenarios ranged from 0.94 (0.84-0.98) to 1.0 (0.93-1.0). The component with the greatest deviation from the reference score was Gestalt clinician concern. There was no significant difference in accuracy between paramedics and EMTs.

Both paramedics and EMTs accurately assigned POPS in this controlled setting. Further research is needed to determine whether EMS clinicians can accurately assign the POPS to actual patients and identify POPS thresholds to guide patient disposition.