Andrew Graeme Rowland
@salford.ac.uk
School of Health and Society
The University of Salford
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Lucy Bray, Bernie Carter, Joann Kiernan, Ed Horowicz, Katie Dixon, James Ridley, Carol Robinson, Anna Simmons, Jennie Craske, Stephanie Sinha,et al.
Springer Science and Business Media LLC
AbstractChildren continue to experience harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care. The international ISupport collaboration aimed to develop standards to outline and explain good procedural practice and the rights of children within the context of a clinical procedure. The rights-based standards for children undergoing tests, treatments, investigations, examinations and interventions were developed using an iterative, multi-phased, multi-method and multi-stakeholder consensus building approach. This consensus approach used a range of online and face to face methods across three phases to ensure ongoing engagement with multiple stakeholders. The views and perspectives of 203 children and young people, 78 parents and 418 multi-disciplinary professionals gathered over a two year period (2020–2022) informed the development of international rights-based standards for the care of children having tests, treatments, examinations and interventions. The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds. Conclusion: This is the first study of its kind which outlines international rights-based procedural care standards from multi-stakeholder perspectives. The standards offer health professionals and educators clear evidence-based tools to support discussions and practice changes to challenge prevailing assumptions about holding or restraining children and instead encourage a focus on the interests and rights of the child. What is Known:• Children continue to experience short and long-term harm when undergoing clinical procedures despite increased evidence of the need to improve the provision of child-centred care.• Professionals report uncertainty and tensions in applying evidence-based practice to children’s procedural care. What is New:• This is the first study of its kind which has developed international rights-based procedural care standards from multi-stakeholder perspectives.• The standards are the first to reach international multi-stakeholder consensus on definitions of supportive and restraining holds.
Louise Brennan, Calvin Heal, Stephen Brown, Damian Roland, and Andrew G Rowland
Wiley
High heart and respiratory rates are key indicators in many published guidelines to identify and treat serious bacterial infection and sepsis in children, but the credibility of evidence underpinning what is considered abnormal is questionable. This study established the distribution of heart and respiratory rates of children using a large data set to inform debate on what the ‘normal’ range of these should look like. The primary aim was to compare the distribution of heart and respiratory rates measured in children recruited from non‐tertiary emergency care settings with those published by Advanced Paediatric Life Support (APLS). The secondary aim was to compare the distribution of this study's data set to other national guidance on what constitutes a severe (high‐risk) measurement and previously published data sets.
Comfort I. Ottah
Routledge
Peggy Mulongo, Andrew Rowland, and Sue McAndrew
Springer International Publishing
Calvin Heal, Anna Harvey, Stephen Brown, Andrew Graeme Rowland, and Damian Roland
Ovid Technologies (Wolters Kluwer Health)
Background and importance Body temperature is considered an independent determinant of respiratory rate and heart rate; however, there is limited scientific evidence regarding the association. This study aimed to assess the association between temperature, and heart rate and respiratory rate in children. Objective The objective of this study was to validate earlier findings that body temperature causes an increase of approximately 10 bpm rise in heart rate per 1 °C rise in temperature, in children aged under 16 years old. Design A prospective study using anonymised prospectively collected patient data of 188 635 attendances, retrospectively extracted from electronic patient records. Settings and participants Four Emergency or Urgent Care Departments in the North West of England. Participants were children and young people aged 0–16 years old who attended one of the four sites over a period of 3 years. Outcome measures and analysis Multiple linear regression models, adjusted for prespecified confounders (including oxygen saturation, heart rate, respiratory rate, site of attendance, age), were used to examine the influence of various variables on heart rate and respiratory rate. Main results Among the 235 909 patient visits (median age 5) included, the mean temperature was 37.0 (SD, 0.8). Mean heart rate and respiratory rate were 115.6 (SD, 29.0) and 26.9 (SD, 8.3), respectively. For every 1 °C increase in temperature, heart rate will on average be 12.3 bpm higher (95% CI, 12.2–12.4), after accounting for oxygen saturation, location of attendance, and age. For every 1 °C increase in temperature, there is on average a 0.3% decrease (95% CI, 0.2–0.4%) in respiratory rate. Conclusion In this study on children attending urgent and emergency care settings, there was an independent association between temperature and heart rate but not between temperature and respiratory rate.
Siobhan Quinn, Elizabeth Dierckx, Tony Long, and Andrew Graeme Rowland
Informa UK Limited
ABSTRACT The sudden, unexpected death of a child (SUDC) is a devastating experience. It is vital that supportive and investigative services are effective and promote the best outcomes for families. Analysis of 5 years of data from 309 SUDC cases in Greater Manchester, United Kingdom (UK) shows how a number of key service outcomes can be measured and achieved through a raft of actions which are commensurate with and exceed the service level recommended by the UK Government. Annual reports covering the work of the Greater Manchester SUDC team are compiled from audit forms completed by the attending SUDC pediatrician for each case. Data from these reports from April 1, 2015 to March 31, 2020 were analyzed. Most cases happened out of normal working hours, predominantly on Sundays. This supports the need for a 24-hour, 7 days per week SUDC service to enable early investigation and timely support for families. The review demonstrated that the Greater Manchester model is able to deliver this in a rapid response with early attendance in emergency departments and early home visits; effective joint agency working with police, children’s social services, and other agencies; and provision of support to families. The proposed instigation of a key worker role in the SUDC team is a welcome development. This is central to ameliorating the experience for parents by providing bereavement support separate from the investigative role of the SUDC team. Research is needed into the role of the key worker, potentially as a dedicated bereavement nurse, and understanding of families’ experiences to ensure that support is optimal.
Dianne L. Cook, Joan Livesley, Tony Long, Mfon Sam, and Andrew Graeme Rowland
Informa UK Limited
ABSTRACT Children and young people (CYP) can be empowered to take on roles as agents of change in their own communities. CYP want to be heard and should be actively involved in the co-production, design and development of services aimed at them to ensure that the resulting services are acceptable and accessible. Little analysis of the framing and discourse of co-production in different contexts has been undertaken. Building on Children’s Advocacy Center models from the United States of America (which are held in high esteem by local communities), there is perceived value of such a center in the UK. A service development initiative was designed to work with children from Greater Manchester (UK) to determine the potential for the establishment of a children’s advocacy center in the North of England. This report presents the design and outcome of the initiative and contributes to the literature on the co-production of such service development projects with CYP, notably the means of achieving that outcome. Recommendations are made for the piloting of an Advocacy House model in the UK with collaborative efforts between CYP as well as health, education, law enforcement, social care providers, charities and voluntary groups. A community-inclusive partnership, underpinned by the principles of co-production and co-design, is integral to the further development of this pilot.
Tony Long, Andrew Rowland, Sarah Cotterill, Steve Woby, Calvin Heal, Natalie Garratt, Steve Brown, and Damian Roland
Informa UK Limited
ABSTRACT There is global acceptance that individuals should be allowed to decide whether or not to take part in research studies, and to do so after being informed about the nature of the research and the risk that might attach to participation. The process of providing detailed information before seeking consent (formalized by signatures) in advance of undertaking research procedures may not be possible in some circumstances, and sometimes an amended approach may be adopted. The use of opt-out consent has been recognized as a valid and ethical means of recruiting participants to studies particularly with large samples and where the risk to participants is small. However, it is sometimes misunderstood and can be a problematic factor in being accepted by research ethics committees and governing authorities. This may be due partly to differing expectations of the amount of information and support offered, together with the nature of the process that is adopted to ensure that a decision has been made rather than consent simply being assumed. In accordance with ongoing discussions with young people, and following consultation with parents, an opt-out consent strategy including varied means of providing information was employed in a large study of 44,501 cases of children attending emergency or urgent care departments. The study was conducted over more than 12 months in dissimilar emergency departments and an urgent care unit, and was designed to support better decision-making in pediatric emergency departments about whether children need to be admitted to hospital or can be discharged home safely. Robust analysis of the factors that exerted the greatest impact on predicting the need to admit or the safety of discharging children led to a revised version of an existing tool. In this article, we review approaches to consent in research, the nature and impact of opt-out consent, the factors that made this an effective strategy for this study, but also more recent concerns which may make opt-out consent no longer acceptable.
Joseph Home and Andrew Rowland
BMJ
Andrew Rowland and Dianne L Cook
BMJ
Children have a right to be heard. Involving children in decision-making and development promotes their rights which can make a positive difference locally and globally on issues that matter to them.1
The United Nations Convention on the Rights of the Child (UNCRC) defines a child as anyone who has not yet reached their 18th birthday. The UNCRC includes obligations of communities and states to fulfil children’s rights2 and includes respect for the views of the child (Article 12) and freedom of expression (Article 13). While seeking children’s views in a tokenistic fashion is wrong, not seeking their input on the basis that it would be tokenistic is also wrong, but arguably not as wrong as not seeking their views at all.3
So, what about …
Calvin Heal, Sarah Cotterill, Andrew Graeme Rowland, Natalie Garratt, Tony Long, Stephen Brown, Grainne O'Connor, Chloe Rishton, Steve Woby, and Damian Roland
BMJ
ObjectiveThe Paediatric Admission Guidance in the Emergency Department (PAGE) score is an assessment tool currently in development that helps predict hospital admission using components including patient characteristics, vital signs (heart rate, temperature, respiratory rate and oxygen saturation) and clinical features (eg, breathing, behaviour and nurse judgement). It aims to assist in safe admission and discharge decision making in environments such as emergency departments and urgent care centres. Determining the inter-rater reliability of scoring tools such as PAGE can be difficult. The aim of this study was to determine the inter-rater reliability of seven clinical components of the PAGE Score.DesignInter-rater reliability was measured by each patient having their clinical components recorded by two separate raters in succession. The first rater was the assessing nurse, and the second rater was a research nurse.SettingTwo emergency departments and one urgent care centre in the North West of England. Measurements were recorded over 1 week; data were collected for half a day at each of the three sites.PatientsA convenience sample of 90 paediatric attendees (aged 0–16 years), 30 from each of the three sites.Main outcome measuresTwo independent measures for each child were compared using kappa or prevalence-adjusted bias-adjusted kappa (PABAK). Bland-Altman plots were also constructed for continuous measurements.ResultsInter-rater reliability ranged from moderate (0.62 (95% CI 0.48 to 0.74) weighted kappa) to very good (0.98 (95% CI 95 to 0.99) weighted kappa) for all measurements except ‘nurse judgement’ for which agreement was fair (0.30, 95% CI 0.09 to 0.50 PABAK). Complete information from both raters on all the clinical components of the PAGE score were available for 73 children (81%). These total scores showed good’ inter-rater reliability (0.64 (95% CI 0.53 to 0.74) weighted kappa).ConclusionsOur findings suggest different nurses would demonstrate good inter-rater reliability when collecting acute assessments needed for the PAGE score, reinforcing the applicability of the tool. The importance of determining reliability in scoring systems is highlighted and a suitable methodology was presented.
Andrew Rowland, Felicity Gerry, Charlotte Proudman, and Joseph Home
Mark Allen Group
The authors of Home et al (2020) respond to the Letter to the Editor on the call for an independent anti-female genital mutilation commissioner in the UK
Felicity Gerry, Charlotte Proudman, Hoda Ali, Joseph Home, and Andrew Graeme Rowland
BMJ
It is heartening that the number of children presenting with female genital mutilation (FGM) in the UK is less than expected from the estimates. This is against a decade of changes to legal frameworks, including introducing FGM Protection Orders (FGMPOs) to protect girls and women at risk, alongside educational efforts to increase public awareness by a range of stakeholders. It is possible that FGM is abandoned after migration to the UK and that antiFGM measures need to be proportionate to the empirical evidence of the risk of FGM in the UK. However, there remain widespread concerns connected to discrimination towards women and girls of which FGM is one facet. A criminal conviction for FGM in England in 2019 focused on witchcraft, rather than the injury and the harm that the girl sustained. In immigration cases, the home office appears to expect medical examinations to prove whether women and girls have had FGM or not, and in family law cases there are concerns that the approach to FGMPOs might have led to disengagement from some individuals, with concerns of a lack of state support to accompany legal measures. The most successful changes appear to be through education and public health prevention strategies. However, we note this with cautionary optimism due to a lack of empirical research, which is clearly imperative. Using a disease progression model, we suggest that the study is visualising the interconnection of legislation and health measures with education campaigns. Interventions can include ‘upstream’ or ‘downstream’ approaches. Downstream approaches are individualised, catering to specific needs. Upstream approaches are systemwide, such as the introduction of FGMPOs. While often seen as a heavyhanded approach by policymakers, the effectiveness of upstream interventions improves over time, as resistance to change fades and subsequent generations grow up with changes normalised. Upstream interventions tend to be cheaper with better health outcomes. This may offer reassurance to the longitudinal effectiveness of antiFGM measures. However, it would be unwise to suggest that effectiveness increases over time without additional interventions. The use of legislation and government policies to change individuals’ and communities’ behaviours, attitudes and practices towards FGM is underresearched. The distance between ontheground impact through education and a legislative response can affect the success not just of eradication of FGM but also the wider necessary reduction in gender inequality. While the improvement of law was useful in 2012, the inflammatory and hyperbolic language centring on one conviction means the application of legal mechanisms risks becoming a barrier to reaching the United Nations ‘Sustainable Development Goals to eradicate FGM’. Upstream interventions are considered more effective in terms of their longevity and equitability. Recognising that legislation alone is not sufficient to achieve the desired outcome but that health, education and law combined have the potential to end FGM in our generation is important.
Mfon Sam, Dianne L. Cook, Andrew G. Rowland, and James Butler
Informa UK Limited
ABSTRACT This study was conducted to understand the reasons parents of children with minor conditions attend the Children’s Emergency Department (ED), and their views about onsite pediatric same day care (SDC) service as an alternative treatment center. The study was a cross-sectional survey of parents attending an inner-city, district general hospital children’s ED, with children aged under 16 years old who were allocated to low triage categories. A convenience sample of 58 parents of 58 children were recruited. All the 58 responses were analyzed. Incomplete questionnaires were not excluded. 47% of attendances were because of minor injury. Most presentations were within 24 hours of the injury or illness. 72% of parents were employed. 91% were registered with a General Practitioner (GP). 29% contacted a GP before the ED visit. The majority of participants who contacted a GP were referred to the ED; others were advised to wait to see if the child’s condition improved and to attend the ED if there were any concerns or the child deteriorated in any way. About 50% of those that did not contact GP said the GP surgery was closed and 8% felt the GP could not help. 90% of parents perceived their child’s condition as urgent requiring immediate treatment. About 33% of parents said they would be happy for their children to be treated at an onsite SDC center. The study showed limited access to GP services in the community and dissatisfaction with community services and perceived urgency of treatment prompted parents of children with minor conditions to attend the ED. This could mean significant ED attendance by children with minor conditions. The majority of the parents in the study would welcome an onsite pediatric SDC if appropriate to meet their children’s care needs. Establishing an onsite SDC may help relieve the ED pressures to attend to more clinically urgent and emergency cases.
Andrew Rowland, Sarah Cotterill, Calvin Heal, Natalie Garratt, Tony Long, Laura Jayne Bonnett, Stephen Brown, Steve Woby, and Damian Roland
BMJ
ObjectivesTo 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.DesignObservational cohort study with internal and external validation of a predictive tool.SettingTwo general emergency departments (EDs) and an urgent care centre in the North of England.ParticipantsThe 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 measuresAdmission 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.ResultsThe 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).ConclusionsFor 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 protocolThe study protocol has been published in an open access journal: Riazet alRefining 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 numberThe protocol has been published and the study registered (NIHR RfPB Grant: PB-PG-0815–20034; ClinicalTrials.gov:213469).
Joseph Home, Andrew Rowland, Felicity Gerry, Charlotte Proudman, and Kimberley Walton
Mark Allen Group
Performing female genital mutilation (FGM) is prohibited within the UK by the FGM Act of 2003. A mandatory reporting duty for FGM requires regulated health and social care professionals and teachers in England and Wales to report known cases of FGM in under 18-year-olds to the police. An application to the court for an FGM protection order (FGMPO) can be made to keep individual women and girls safe from FGM. This paper reveals the significant disconnect between the number of FGMPO applications and known recorded cases of FGM. The introduction of FGMPOs requires critical exploration as there is insufficient evidence to show that FGMPOs are effective in protecting women and girls from FGM. It is therefore unclear what impact, if any, FGMPOs are having upon the protection of women and girls at risk of FGM. The barriers to the implementation of FGMPOs and possible solutions are discussed.
Andrew Graeme Rowland and Keerthi Mohan
Mark Allen Group
NHS organisations must be assured that appropriate protections and support are in place for their employees, especially when incidents occur or concerns arise. These assurances are an essential part of fostering a just and inclusive culture under an overarching banner of compassionate leadership, while also ensuring that any concerns are properly investigated. In mid-2019, the General Medical Council published their Hamilton review into Gross Negligence Manslaughter. As a result, NHS Improvement wrote to NHS trusts about managing local investigation processes for disciplinary investigations of all types. Employers and educators of healthcare professionals have a responsibility to consider how they will put these recommendations and requirements into practice, yet there is currently no clear implementation guidance. The authors make implementation recommendations that should be considered by NHS organisations and Health Education England as part of their compassionate leadership and just culture processes.
Damian T Roland, Andrew Rowland, Sarah Cotterill, Calvin Heal, Steve Woby, Natalie Garratt, Stephen Brown, and Tony Long
BMJ
Reluctance of the Royal College of General Practitioners to endorse NEWS2 (the second iteration of the national early warning score) has surprised some and been supported by others.1 This dichotomy over what seems to be a proved safety measure shows the fine balance between pragmatism and rigidness in system approaches to acute care.
The predictive value of NEWS2 is well evidenced,2 and acting on a high score might prevent excess mortality, leading to …
Peter J Lillitos, Mark D Lyttle, Damian Roland, Colin VE Powell, Julian Sandell, Andrew G Rowland, Susan M Chapman, and Ian K Maconochie
BMJ
BackgroundClarifying whether paediatric early warning scores (PEWS) accurately predict significant illness is a research priority for UK and Ireland paediatric emergency medicine (EM). However, a standardised list of significant conditions to benchmark these scores does not exist.ObjectivesTo establish standardised significant illness endpoints for use in determining the performance accuracy of PEWS and safety systems in emergency departments (ED), using a consensus of expert opinion in the UK and Ireland.DesignBetween July 2017 and February 2018, three online Delphi rounds established a consensus on ‘significant’ clinical conditions, derived from a list of common childhood illness/injury ED presentations. Conditions warranting acute hospital admission in the opinion of the respondent were defined as ‘significant’, using a 5-point Likert scale. The consensus was a priori ≥80% (positive or negative). 258 clinical conditions were tested.Participants and settingsEligible participants were consultants in acute or EM paediatrics, or adult EM, accessed via 53 PERUKI (Paediatric Emergency Research in the UK and Ireland)’s research collaborative sites, and 27 GAPRUKI (General and Adolescent Paediatric Research in the UK and Ireland)’s sites, 17 of which overlap with PERUKI.Main outcome measuresTo create a list of conditions regarded as ‘significant’with ≥80% expert consensus.Results43 (68%) of 63 PERUKI and GAPRUKI sites responded; 295 experts were invited to participate. Participants in rounds 1, 2 and 3 were 223 (76%), 177 (60%) and 148 (50%), respectively; 154 conditions reached positive consensus as ‘significant’; 1 condition reached a negative consensus (uncomplicated Henoch-Schönlein purpura); and 37 conditions achieved non-consensus.ConclusionsA list of significant childhood conditions has been created using UK and Irish expert consensus, for research purposes, for the first time. This will be used as the benchmark endpoint list for future research into PEWS/safety systems performance in EDs.
Samah Riaz, Andrew Rowland, Steve Woby, Tony Long, Joan Livesley, Sarah Cotterill, Calvin Heal, and Damian Roland
Springer Science and Business Media LLC
Yusuf Malik, Andrew Rowland, Felicity Gerry, and Fiona MacVane Phipps
Mark Allen Group
Background While female genital mutilation (FGM) has been illegal in the UK since 1985, research estimated that in 2015 there were over 100 000 women and girls resident in the UK subjected to FGM. Aims To determine the effect of changes in the legislation of 2015, which made reporting of FGM in girls under 18 mandatory. Methods Freedom of Information requests were sent to all 45 UK police authorities, asking the number of cases of FGM reported between specific dates, victims' ages, the occupation of the person reporting and the age and gender breakdown of the police force. Similar requests were sent to health and social care organisations. Findings Of 45 police authorities in the UK, six initially responded, with three stating that no cases of FGM had been reported. The remaining police authorities either provided partial information or declined the request. However, other sources indicated over 6000 reported cases between October 2014 and October 2015. Conclusions The ability of frontline professionals and policymakers to obtain, interpret and use data is affected by the secrecy that surrounds FGM, the complexities of investigation and the absence of a significant numbers of prosecutions.
Andrew Rowland, Felicity Gerry, and Marcia Stanton
Brill
As at March 2016, 49 states had reformed their laws to clearly prohibit all corporal punishment of children (United Nations 1989) in all settings, including the home (Global Initiative to End All Corporal Punishment of Children, n.d.) By January 2017 this number had reached 52. As the trend moves towards abolition, it is not an acceptable position for the United Kingdom (uk), the United States of America (usa) and Australia (Poulsen, 2015) to remain missing from that list. Whilst they are, effectively, a child (a person aged under 18 years of age), is the only person in all three countries that it is legal to hit. This article seeks to restate arguments in this area in a simple way to restart the debate in a modern context where understanding of child abuse is perhaps more widespread than it ever was in the past. On 20 October 2014 a report, Living on a Railway Line, was launched in the uk to mark the 25th anniversary of the signing of the un Convention on the Rights of the Child, which took place on 20 November 1989 (Rowland, 2014). It recommended removing the defence of reasonable chastisement in relation to the punishment of children. This article seeks to build on that agenda in a comparative context taking a three way perspective from the uk, the usa and Australia. It concludes that moves to prevent family violence are progressive but the position of a society where physical punishment of children is permitted yet child abuse is forbidden is not a tenable one. Reducing the number of cases of child abuse must begin with a clear message from society that physical punishment of children, whatever the circumstances, is unacceptable. The situation is serious enough to introduce aspirational legislation to remove justifications for physical punishment of children with the aim of modifying behaviour within society.
Sarah Cotterill, Andrew G Rowland, Jacqueline Kelly, Helen Lees, and Mohammed Kamara
BMJ
Background The Pennine Acute Trust (PAT) Paediatric Observation Priority Score (PAT-POPS) is a specific emergency department (ED) physiological and observational aggregate scoring system, with scores of 0–18. A higher score indicates greater likelihood of admission. The Manchester Children's Early Warning System (ManChEWS) assesses six physiological observations to create a trigger score, classified as Green, Amber or Red. Methods Prospectively collected data were used to calculate PAT-POPS and ManChEWS on 2068 patients aged under 16 years (mean 5.6 years, SD 4.6) presenting over 1 month to a UK District General Hospital Paediatric ED. Receiver operating characteristics (ROC) comparison, using STATA V.13, was used to investigate the ability of ManChEWS and PAT-POPS to predict admission to hospital within 72 h of presentation to the ED. Results Comparison of the area under the ROC curve indicates that the ManChEWS ROC is 0.67 (95% CI 0.64 to 0.70) and the PAT-POPS ROC is 0.72 (95% CI 0.68 to 0.75). The difference is statistically significant. At a PAT-POPS cut-off of ≥2, 80% of patients had their admission risk correctly classified (positive likelihood ratio 3.40, 95% CI 2.90 to 3.98) whereas for ManChEWS with a cut off of ≥Amber only 71% of patients were correctly classified (positive likelihood ratio 2.18, 95% CI 1.94 to 2.45). Conclusions PAT-POPS is a more accurate predictor of admission risk than ManChEWS. Replacing ManChEWS with PAT-POPS would appear to be clinically appropriate in a paediatric ED. This needs validation in a multicentre study.
Felicity Gerry, Andrew Rowland, Sam Fowles, Suzanne Smith, Deborah Hodes, and Sarah Creighton
BMJ
Female genital mutilation (FGM) is an extremely harmful crime against women and girls involving intentional altering of the female genitalia for non-medical reasons. It may have devastating health consequences. Performing, or assisting in the performance of, FGM in the UK or by taking a child abroad carries a maximum prison sentence of 14 years in the UK.1–3 However, there has yet to be a successful prosecution for FGM in the UK.
On 31 October 2015, section 5B of the Female Genital Mutilation Act 2003 came into force. This legislation introduced a new duty on healthcare professionals4 to report cases of FGM in girls under the age of 18 years. The duty on the regulated professional is mandatory and …