Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Rio de Janeiro, RJ, Brazil; Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil.
Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil.
J Pediatr (Rio J). 2022 Jul-Aug;98(4):369-375. doi: 10.1016/j.jped.2021.08.004. Epub 2021 Sep 24.
To evaluate the validity of the computerized version of the pediatric triage system CLARIPED.
Prospective, observational study in a tertiary emergency department (ED) from Jan-2018 to Jan-2019. A convenience sample of patients aged 0-18 years who had computerized triage and outcome variables registered. Construct validity was assessed through the association between urgency levels and patient outcomes. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), undertriage, and overtriage rates were assessed.
19,122 of 38,321 visits were analyzed. The urgency levels were: RED (emergency) 0.02%, ORANGE (high urgency) 3.21%, YELLOW (urgency) 35.69%, GREEN (low urgency) 58.46%, and BLUE (no urgency) 2.62%. The following outcomes increased according to the increase in the level of urgency: hospital admission (0.4%, 0.6%, 3.1%, 11.9% and 25%), stay in the ED observation room (2.8%, 4.7%, 15.9%, 40.4%, 50%), ≥ 2 diagnostic or therapeutic resources (7.8%, 16.5%, 33.7%, 60.6%, 75%), and ED length of stay in minutes (18, 24, 67, 120, 260). The odds of using ≥ 2 resources or being hospitalized were significantly greater in the most urgent patients (Red, Orange, and Yellow) compared to the least urgent (Green and Blue): OR 7.88 (95%CI: 5.35-11.6) and OR 2.85 (95%CI: 2.63-3.09), respectively. The sensitivity to identify urgency was 0.82 (95%CI: 0.77-0.85); specificity, 0.62 (95%CI: 0.61-0.6; NPV, 0.99 (95%CI: 0.99-1.00); overtriage rate, 4.28% and undertriage, 18.41%.
The computerized version of CLARIPED is a valid and safe pediatric triage system, with a significant correlation with clinical outcomes, good sensitivity, and low undertriage rate.
评估儿科分诊系统 CLARIPED 的计算机版本的有效性。
这是一项 2018 年 1 月至 2019 年 1 月在三级急诊部进行的前瞻性观察性研究。便利选择了计算机分诊并记录了结局变量的 0-18 岁患者。通过紧急程度与患者结局之间的关联来评估结构有效性。评估了敏感性、特异性、阳性和阴性预测值（PPV 和 NPV）、分诊不足率和分诊过度率。
分析了 38321 次就诊中的 19122 次。紧急程度如下：红色（紧急）0.02%、橙色（高紧急）3.21%、黄色（紧急）35.69%、绿色（低紧急）58.46%和蓝色（无紧急）2.62%。以下结局随着紧急程度的增加而增加：住院（0.4%、0.6%、3.1%、11.9%和 25%）、在 ED 观察室停留（2.8%、4.7%、15.9%、40.4%、50%）、≥2 种诊断或治疗资源（7.8%、16.5%、33.7%、60.6%、75%）和 ED 停留时间（18、24、67、120、260）。与最不紧急的（绿色和蓝色）相比，最紧急的患者（红色、橙色和黄色）使用≥2 种资源或住院的可能性明显更大：比值比 7.88（95%CI：5.35-11.6）和比值比 2.85（95%CI：2.63-3.09）。识别紧急程度的敏感性为 0.82（95%CI：0.77-0.85）；特异性，0.62（95%CI：0.61-0.6）；NPV，0.99（95%CI：0.99-1.00）；过度分诊率为 4.28%，分诊不足率为 18.41%。
CLARIPED 的计算机版本是一种有效且安全的儿科分诊系统，与临床结局有显著相关性，敏感性好，分诊不足率低。
