巴西儿科分诊系统 CLARIPED 在二级急救中的有效性。
Validity of the Brazilian pediatric triage system CLARIPED at a secondary level of emergency care.
机构信息
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; Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil.
出版信息
J Pediatr (Rio J). 2023 May-Jun;99(3):247-253. doi: 10.1016/j.jped.2022.10.005. Epub 2022 Nov 18.
OBJECTIVE
To evaluate the validity of the triage system CLARIPED in a pediatric population in the city of São Paulo, Brazil.
METHODS
Prospective, observational study in a secondary-level pediatric emergency service from Sep-2018 to Ago-2019. A convenience sample of all patients aged 0-18 years triaged by the computerized CLARIPED system was selected. Associations between urgency levels and patient outcomes were analyzed to assess construct validity. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) to identify the most urgent patients were estimated, as well as under-triage and over-triage rates.
RESULTS
The distribution of 24,338 visits was: RED 0.02%, ORANGE 0.9%, YELLOW 23.5%, GREEN 47.9%, and BLUE 27.7% (highest to the lowest level of urgency). The frequency of the following outcomes increased with increasing urgency: hospital admission (0.0%, 0.02%, 0.1%, 7.1% and 20%); stay in ED observation room (1.9%, 2,4%, 4.8%, 24.1%, 60%); use of ≥ 2 diagnostic/therapeutic resources (2.3%, 3.0%, 5.9%, 28.8%, 40%); ED length of stay (12, 12, 15, 99.5, 362 min). The most urgent patients (RED, ORANGE, and YELLOW) exhibited higher chances of using ≥ 2 resources (OR 2.55; 95%CI: 2.23-2.92) or of being hospitalized (OR 23.9; 95%CI: 7.17-79.62), compared to the least urgent (GREEN and BLUE). The sensitivity to identify urgency was 0.88 (95%CI: 0.70-0.98); specificity, 0.76 (95%CI: 0.75-0.76); NPV, 0.99 (95%CI: 0.99-1.00); overtriage rate, 23.0%, and undertriage, 11.5%.
CONCLUSION
This study corroborates the validity and safety of CLARIPED, demonstrating significant correlations with clinical outcomes, good sensitivity, and low undertriage rate in a secondary-level Brazilian pediatric emergency service.
目的
评估 CLARIPED 分诊系统在巴西圣保罗市儿科人群中的有效性。
方法
这是一项 2018 年 9 月至 2019 年 8 月在二级儿科急诊服务中进行的前瞻性观察性研究。选择所有通过计算机 CLARIPED 系统分诊的 0-18 岁患者进行便利抽样。分析危急程度与患者结局之间的关联，以评估结构效度。还评估了识别最危急患者的灵敏度、特异度、阳性和阴性预测值（PPV 和 NPV），以及分诊不足和分诊过度的发生率。
结果
24338 次就诊的分布情况为：红色 0.02%，橙色 0.9%，黄色 23.5%，绿色 47.9%，蓝色 27.7%（由高到低）。随着危急程度的增加，以下结局的发生频率增加：住院（0.0%、0.02%、0.1%、7.1%和 20%）；急诊观察室留观（1.9%、2%、4.8%、24.1%、60%）；使用≥2 种诊断/治疗资源（2.3%、3.0%、5.9%、28.8%、40%）；急诊停留时间（12、12、15、99.5、362 分钟）。最危急的患者（红色、橙色和黄色）使用≥2 种资源（比值比 2.55；95%置信区间：2.23-2.92）或住院的可能性更高（比值比 23.9；95%置信区间：7.17-79.62），与最不危急的患者（绿色和蓝色）相比。识别危急程度的灵敏度为 0.88（95%置信区间：0.70-0.98）；特异度为 0.76（95%置信区间：0.75-0.76）；NPV 为 0.99（95%置信区间：0.99-1.00）；分诊过度率为 23.0%，分诊不足率为 11.5%。
结论
这项研究证实了 CLARIPED 的有效性和安全性，在巴西二级儿科急诊服务中，与临床结局具有显著相关性，灵敏度较高，分诊不足率较低。
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