The PATRIARCH * study. Using outcome measures for league tables: can a North American prediction of admission score be used in a United Kingdom children's emergency department? .

Objectives: The use of league tables has become predominant in the healthcare culture of the United Kingdom. These tables are often based on measures that are viewed with scepticism by clinicians. This study was designed to test the validity of a North American risk of admission score, the PRISA, for use in a United Kingdom population of accident and emergency (A&E) attendees.

Methods: All attendees to a children's A&E department were scored using the PRISA for a single calendar month (November 2000)

Results: 701 children were studied in total. The results show that the PRISA applied to this population gives an area under the receiver operator curve of 0.76. Of the 701 patients studied, 206 (29.4%) were admitted. The PRISA predicted a total of 206.10 admissions. Of the 50 patients discharged with the highest PRISA scores (that is, with the highest likelihood of admission), none were admitted in the 48 hours after their original attendance.

Conclusions: These results show that the PRISA is suitable as a measure of paediatric A&E department performance in the United Kingdom and it is highly promising as a future measure of quality.

**********

The paediatric risk of admission score (PRISA) was developed and validated in North America to assess performance, as measured by illness severity compared with admission rates to a hospital bed after assessment in a children's emergency department.' In view of the scepticism surrounding the validity of comparisons upon which hospital league tables are based, (2-7) this study was designed to assess the suitability of such a score applied to a UK population and healthcare service in order to explore the possibility of developing its use in the future to increase the value of league table data.

METHODS

Setting

The Accident and Emergency Department at Bristol Royal Hospital for Sick Children is part of a tertiary referral hospital and receives about 15000 patients a year, 12 500(83%) of whom are first time attendees. The department is staffed by one full time consultant, two registrars, and five senior house officers.

Population

Patients come from the greater Bristol area and attend the department by self referral, general practitioner referral, or direct ambulance transport. The population of Bristol is predominantly white, 94.9% white, 2.1% coloured, 2.4% black, and 0.6% other. During a single calendar month (November 2000), all attendees to the accident and emergency (A&E) department were scored on the PRISA.

Data collection and analysis

The outcome of the visit was recorded (admission or non-admission to a hospital bed) as well as details of category of illness and final clinical diagnosis. Clinical measurements were made …