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Prehospital use of the paediatric observation priority score

02 August 2023
Volume 15 · Issue 8



In the prehospital setting, the incidence of seriously unwell children is low and emergency medical staff have repeatedly expressed concerns about their confidence and knowledge with regard to assessing children. The paediatric observation priority score (POPS) was designed in response to concerns about the identification of seriously unwell children. The ambulance service in this study began to implement POPS in 2018.


To examine the use and documentation of POPS by ambulance staff in a Welsh health board.


A retrospective cross-sectional study was carried out, covering 121 paediatric patients over 3 months with data collected from patient clinical records.


Patient observations were well documented (77.7%), score accuracy was high (82%) and the majority of patients were pre-alerted appropriately (80% of POPS 7). Statistically significant associations were drawn between patient age and observations as well as between POPS and patient outcomes. However, compliance with POPS was only 32.3%.


Although the use of POPS is relatively low, children mainly did have relevant observations recorded and when POPS was used, it was accurate. Education and training would improve compliance. Future research recommendations include investigating the education and confidence of emergency medical staff regarding paediatric patients.

Concerns have been raised about the UK child mortality rate, specifically in comparison to that in other European countries (Wolfe et al, 2014). Although infant mortality rates in England and Wales have generally declined since the 1980s, the most recent 2021 data show rates have increased since 2020 (Office for National Statistics, 2023). Furthermore, in recent literature, concerns have been expressed about poor confidence and knowledge regarding paediatric assessment, often by staff themselves, and attributed to the low incidence of these patient contacts (Butler and Adefuye, 2019; Jeruzal et al, 2019; Hetherington and Jones, 2021).

Paediatric early warning scores (PEWS) are commonly implemented as a patient safety measure to improve the quality of care for children (Sefton et al, 2015; Corfield et al, 2018; de Groot et al, 2018; Sambeeck et al, 2018). Many variations exist in practice and, despite the increasing use of PEWS, they are frequently not validated (Chapman et al, 2017; de Groot et al, 2018; Sambeeck et al, 2018), particularly in the prehospital setting (Roland et al, 2017). However, work is under way in England to develop a standardised system (Royal College of Paediatrics and Child Health (RCPCH), 2023).

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