title: Diagnostic accuracy of PAT-POPS and ManChEWS for admissions of children from the emergency department.
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.
authors.affiliation: Centre for Biostatistics, University of Manchester, Manchester, UK.
authors.forename: Sarah
authors.initials: S
authors.lastname: Cotterill
authors.affiliation: Emergency Department, North Manchester General Hospital, Manchester, UK.|The University of Salford, Salford, UK.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Rowland
authors.affiliation: Emergency Department, North Manchester General Hospital, Manchester, UK.
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Kelly
authors.affiliation: Emergency Department, North Manchester General Hospital, Manchester, UK.
authors.forename: Helen
authors.initials: H
authors.lastname: Lees
authors.affiliation: Emergency Department, North Manchester General Hospital, Manchester, UK.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Kamara
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000145:classification* / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016013:Likelihood Functions; D008297:Male; D010343:Patient Admission / Q000706:statistics & numerical data*; D061214:Patient Safety / Q000706:statistics & numerical data; D011446:Prospective Studies; D012372:ROC Curve; D012720:Severity of Illness Index
keywords: assessment; emergency department; hospitalisations; paediatric emergency med; paediatrics, paediatric emergency medicine