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

> **NIH AHRQ K08** · CHILDREN'S RESEARCH INSTITUTE · 2024 · $141,998

## Abstract

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 expert...

## Key facts

- **NIH application ID:** 10983593
- **Project number:** 1K08HS029515-01A1
- **Recipient organization:** CHILDREN'S RESEARCH INSTITUTE
- **Principal Investigator:** Caleb Ward
- **Activity code:** K08 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2024
- **Award amount:** $141,998
- **Award type:** 1
- **Project period:** 2024-08-01 → 2029-07-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10983593

## Citation

> US National Institutes of Health, RePORTER application 10983593, Improving risk prediction for children seeking emergency medical services (EMS) care with non-emergent complaints (1K08HS029515-01A1). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10983593. Licensed CC0.

---

*[NIH grants dataset](/datasets/nih-grants) · CC0 1.0*