Starvaggi Carl A, Affentranger Sophie, Lengeler Noelie, Siebert Johan N, Galetto-Lacour Annick, Tan Rainer, Jaboyedoff Manon, Kuehni Claudia E, Hartley Mary-Anne, Keitel Kristina
Division of Pediatric Emergency Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland.
Department of Orthopedic Surgery and Traumatology, Spitalzentrum Oberwallis, Brig, Switzerland.
Mayo Clin Proc Digit Health. 2025 Apr 15;3(2):100220. doi: 10.1016/j.mcpdig.2025.100220. eCollection 2025 Jun.
To prospectively validate InfoKids+, a pediatric acuity electronic risk stratification algorithm (eRSA), against a nurse-based triage standard (nbTS).
We conducted a prospective validation study in a Swiss university hospital pediatric emergency department to assess the performance of a pediatric acuity eRSA, InfoKids+, on the basis of a well-established parental guidance application, InfoKids. Participants completed the eRSA once seated in a consultation booth. We compared the acuity levels from InfoKids+ (urgent, <4 hours; nonurgent, <24 hours; and no emergency, ≥24 hours) against an nbTS. The primary outcome was the level of agreement and rate of alignment between InfoKids+ and the reference standard.
We included 1990 participants from June 3, 2020, through January 31, 2022. InfoKids+ showed a slight level of agreement with the nbTS (κ=0.08; 95% CI, 0.06-0.10). InfoKids+ triaged 1762 (89%) cases as urgent (<4 hours), 106 (5%) as nonurgent (≤24 hours), and 122 (6%) as no emergency (≥24 hours), compared with 810 (41%), 843 (42%), and 337 (17%) triages by the nbTS, respectively (<.001). InfoKids+ acuity level aligned with the reference standard in 888 (45%) cases, whereas it overreferred and underreferred in 999 (50%) and 103 (5%) cases, respectively (<.001).
In summary, our study uncovered notable discrepancies between the InfoKids+ algorithmic triage and conventional nurse-based triage. Our results highlight the critical need for rigorous validation of such tools for accuracy and safety before public release to ensure these tools are beneficial and do not inadvertently cause harm or misallocation of resources.
前瞻性地验证儿科急症电子风险分层算法InfoKids+相对于基于护士的分诊标准（nbTS）的有效性。
我们在一家瑞士大学医院的儿科急诊科进行了一项前瞻性验证研究，以评估基于成熟的家长指导应用程序InfoKids的儿科急症电子风险分层算法InfoKids+的性能。参与者在咨询室就座后完成电子风险分层评估。我们将InfoKids+的急症级别（紧急，<4小时；非紧急，<24小时；无急症，≥24小时）与nbTS进行比较。主要结果是InfoKids+与参考标准之间的一致程度和匹配率。
我们纳入了从2020年6月3日至2022年1月31日的1990名参与者。InfoKids+与nbTS的一致程度较低（κ=0.08；95%置信区间，0.06 - 0.10）。InfoKids+将1762例（89%）病例分诊为紧急（<4小时），106例（5%）为非紧急（≤24小时），122例（6%）为无急症（≥24小时），而nbTS分别分诊了810例（41%）、843例（42%）和337例（17%）（P<.001）。InfoKids+的急症级别与参考标准在888例（45%）病例中匹配，而在999例（50%）和103例（5%）病例中分别过度分诊和分诊不足（P<.001）。
总之，我们的研究发现InfoKids+算法分诊与传统的基于护士的分诊之间存在显著差异。我们的结果凸显了在公开发布此类工具之前，对其准确性和安全性进行严格验证的迫切需求，以确保这些工具有益且不会无意中造成伤害或资源分配不当。
