PMID- 33384399
OWN - NLM
STAT- MEDLINE
DCOM- 20210326
LR  - 20211006
IS  - 2044-6055 (Electronic)
IS  - 2044-6055 (Linking)
VI  - 10
IP  - 12
DP  - 2020 Dec 31
TI  - 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.
PG  - e043864
LID - 10.1136/bmjopen-2020-043864 [doi]
LID - e043864
AB  - 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).
CI  - (c) Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY. Published 
      by BMJ.
FAU - Rowland, Andrew
AU  - Rowland A
AD  - CYP@Salford, School of Health and Society, University of Salford, Salford, UK.
AD  - Emergency Department, North Manchester General Hospital, The Pennine Acute 
      Hospitals NHS Trust, Manchester, UK.
FAU - Cotterill, Sarah
AU  - Cotterill S
AD  - Centre for Biostatistics, School of Health Sciences, The University of 
      Manchester, Manchester, UK.
FAU - Heal, Calvin
AU  - Heal C
AD  - Centre for Biostatistics, School of Health Sciences, The University of 
      Manchester, Manchester, UK.
FAU - Garratt, Natalie
AU  - Garratt N
AD  - Northern Care Alliance NHS Group, Salford Royal Hospital, Salford, UK.
FAU - Long, Tony
AU  - Long T
AD  - CYP@Salford, School of Health and Society, University of Salford, Salford, UK.
FAU - Bonnett, Laura Jayne
AU  - Bonnett LJ
AUID- ORCID: 0000-0002-6981-9212
AD  - Department of Biostatistics, University of Liverpool, Liverpool, UK.
FAU - Brown, Stephen
AU  - Brown S
AD  - Northern Care Alliance NHS Group, Salford Royal Hospital, Salford, UK.
FAU - Woby, Steve
AU  - Woby S
AD  - CYP@Salford, School of Health and Society, University of Salford, Salford, UK.
AD  - Northern Care Alliance NHS Group, Salford Royal Hospital, Salford, UK.
FAU - Roland, Damian
AU  - Roland D
AUID- ORCID: 0000-0001-9334-5144
AD  - SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK 
      dr98@le.ac.uk.
AD  - Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children's 
      Emergency Department, University Hospitals of Leicester NHS Trust, Leicester, UK.
LA  - eng
GR  - PB-PG-0815-20034/DH_/Department of Health/United Kingdom
PT  - Journal Article
PT  - Observational Study
PT  - Research Support, Non-U.S. Gov't
DEP - 20201231
PL  - England
TA  - BMJ Open
JT  - BMJ open
JID - 101552874
SB  - IM
MH  - Adolescent
MH  - Child
MH  - Cohort Studies
MH  - *Emergency Service, Hospital
MH  - England
MH  - Female
MH  - Hospitals
MH  - Humans
MH  - *Munchausen Syndrome
MH  - Risk Assessment
MH  - *State Medicine
PMC - PMC7780516
OTO - NOTNLM
OT  - accident & emergency medicine
OT  - paediatric A&E and ambulatory care
OT  - protocols & guidelines
COIS- Competing interests: None declared.
EDAT- 2021/01/02 06:00
MHDA- 2021/03/27 06:00
PMCR- 2020/12/31
CRDT- 2021/01/01 05:17
PHST- 2021/01/01 05:17 [entrez]
PHST- 2021/01/02 06:00 [pubmed]
PHST- 2021/03/27 06:00 [medline]
PHST- 2020/12/31 00:00 [pmc-release]
AID - bmjopen-2020-043864 [pii]
AID - 10.1136/bmjopen-2020-043864 [doi]
PST - epublish
SO  - BMJ Open. 2020 Dec 31;10(12):e043864. doi: 10.1136/bmjopen-2020-043864.