Dataset Information

Observational cohort study with internal and external validation of a predictive tool for identification of children in need of hospital admission from the emergency department: the Paediatric Admission Guidance in the Emergency Department (PAGE) score.

ABSTRACT:

Objectives

To devise an assessment tool to aid discharge and admission decision-making in relation to children and young people in hospital urgent and emergency care facilities, and thereby improve the quality of care that patients receive, using a clinical prediction modelling approach.

Design

Observational cohort study with internal and external validation of a predictive tool.

Setting

Two general emergency departments (EDs) and an urgent care centre in the North of England.

Participants

The eligibility criteria were children and young people 0-16 years of age who attended one of the three hospital sites within one National Health Service (NHS) organisation. Children were excluded if they opted out of the study, were brought to the ED following their death in the community or arrived in cardiac arrest when the heart rate and respiratory rate would be unmeasurable.

Main outcome measures

Admission or discharge. A participant was defined as being admitted to hospital if they left the ED to enter the hospital for further assessment, (including being admitted to an observation and assessment unit or hospital ward), either on first presentation or with the same complaint within 7?days. Those who were not admitted were defined as having been discharged.

Results

The study collected data on 36?365 participants. 15?328 participants were included in the final analysis cohort (21?045 observations) and 17?710 participants were included in the validation cohort (23?262 observations). There were 14 variables entered into the regression analysis. Of the 13 that remained in the final model, 10 were present in all 500 bootstraps. The resulting Paediatric Admission Guidance in the Emergency Department (PAGE) score demonstrated good internal validity. The C-index (area under the ROC) was 0.779 (95% CI 0.772 to 0.786).

Conclusions

For units without the immediate availability of paediatricians the PAGE score can assist staff to determine risk of admission. Cut-off values will need to be adjusted to local circumstance.

Study protocol

The study protocol has been published in an open access journal: Riaz et al Refining and testing the diagnostic accuracy of an assessment tool (Pennine Acute Hospitals NHS Trust-Paediatric Observation Priority Score) to predict admission and discharge of children and young people who attend an ED: protocol for an observational study. BMC Pediatr 18, 303 (2018). https://doi.org/10.1186/s12887-018-1268-7.

Trial registration number

The protocol has been published and the study registered (NIHR RfPB Grant: PB-PG-0815-20034; ClinicalTrials.gov:213469).

SUBMITTER: Rowland A

PROVIDER: S-EPMC7780516 | biostudies-literature | 2020 Dec

REPOSITORIES: biostudies-literature

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Publications

Observational cohort study with internal and external validation of a predictive tool for identification of children in need of hospital admission from the emergency department: the Paediatric Admission Guidance in the Emergency Department (PAGE) score.

Rowland Andrew A Cotterill Sarah S Heal Calvin C Garratt Natalie N Long Tony T Bonnett Laura Jayne LJ Brown Stephen S Woby Steve S Roland Damian D

BMJ open 20201231 12

<h4>Objectives</h4>To devise an assessment tool to aid discharge and admission decision-making in relation to children and young people in hospital urgent and emergency care facilities, and thereby improve the quality of care that patients receive, using a clinical prediction modelling approach.<h4>Design</h4>Observational cohort study with internal and external validation of a predictive tool.<h4>Setting</h4>Two general emergency departments (EDs) and an urgent care centre in the North of Engla ...[more]

PMID: 33384399

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Dataset Information

Observational cohort study with internal and external validation of a predictive tool for identification of children in need of hospital admission from the emergency department: the Paediatric Admission Guidance in the Emergency Department (PAGE) score.

Objectives

Design

Setting

Participants

Main outcome measures

Results

Conclusions

Study protocol

Trial registration number

Publications

Observational cohort study with internal and external validation of a predictive tool for identification of children in need of hospital admission from the emergency department: the Paediatric Admission Guidance in the Emergency Department (PAGE) score.

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