Improving risk prediction for children seeking emergency medical services (EMS) care with non-emergent complaints

ABSTRACT: Approximately 1.6 million children access the healthcare system through Emergency Medical Services (EMS) each year in the U.S. Despite an absence of validated EMS triage tools, 30% of all children are left at the scene, while many low acuity children are transported to an emergency department (ED) unnecessarily. This non-standardized EMS approach results in both under-triage and over-triage of children. The use of EMS for non-emergent complaints is unsafe because it causes delays in EMS response times for other patients and exacerbates ED overcrowding. Current EMS triage tools were not designed to identify children who can be safely managed without emergent transport to the ED. There is an urgent need for a pediatric EMS risk assessment tool (similar to the Emergency Severity Index [ESI] ED triage score developed with support from the Agency for Healthcare Research and Quality [AHRQ]). The Pediatric Observation Priority Score (POPS) was developed to identify children at low risk of deterioration in emergency settings. POPS has been validated in EDs with moderate/excellent inter-rater reliability between different healthcare professionals and is used in some EMS agencies in the United Kingdom. The acceptability and accuracy of the POPS tool in EMS is unknown. The overall goal of this proposal is to refine and pilot-test the POPS tool for use by EMS clinicians. This will be achieved through the following specific aims: (1) identify factors associated with under- triage for children not transported by EMS; (2) optimize the acceptability, appropriateness, and feasibility of the POPS tool with clinical end-users; and (3) assess the refined POPS tool through simulation and field pilot studies. Aim 1 will be conducted in a multisite retrospective analysis linking EMS records and Medicaid Claims data (a high-risk population). The POPS tool will be refined by incorporating factors found to be associated with under-triage. Aim 2 will be addressed using a mixed-methods approach with EMS clinicians. The POPS tool will be refined and iteratively assessed before pilot testing. Aim 3 will involve assessing the refined POPS tool in simulations with EMS clinicians and a feasibility field pilot test linking POPS scores with patient outcomes. These studies will generate preliminary data on tool accuracy and under and over-triage rates, leading to a national effectiveness trial of the refined POPS tool. A validated pediatric screening tool would enable urgently needed studies of EMS innovations (including treatment in place, telemedicine, and integration of primary care) for children, an AHRQ priority population. The Principal Investigator, Dr. Caleb Ward, is an early career physician-scientist with a strong clinical background in pediatrics, emergency medicine, and EMS. This award will foster his development as a researcher with content expertise in large database analytics, multisite EMS research, and implementation science. A mentorship team with expertise in these content areas will support Dr. Ward as he completes these research aims and related career development activities to ensure his transition to research independence.