VALIDITY AND RELIABILITY OF A NEW TRIAGE SYSTEM FOR PEDIATRIC EMERGENCY CARE: CLARIPED

Overview

Journal Rev Paul Pediatr

Specialty Pediatrics

Date 2018 Dec 13

PMID 30540107

Citations 4

Authors

Maria Clara de Magalhaes-Barbosa

Arnaldo Prata-Barbosa

Carlos Eduardo Raymundo

Antonio Jose Ledo Alves da Cunha

Claudia de Souza Lopes

Affiliations

Soon will be listed here.

Abstract

Objective: To assess the validity and reliability of a triage system for pediatric emergency care (CLARIPED) developed in Brazil.

Methods: Validity phase: prospective observational study with children aged 0 to 15 years who consecutively visited the pediatric emergency department (ED) of a tertiary hospital from July 2 to 18, 2013. We evaluated the association of urgency levels with clinical outcomes (resource utilization, ED admission rate, hospitalization rate, and ED length of stay); and compared the CLARIPED performance to a reference standard. Inter-rater reliability phase: a convenience sample of patients who visited the pediatric ED between April and July 2013 was consecutively and independently double triaged by two nurses, and the quadratic weighted kappa was estimated.

Results: In the validity phase, the distribution of urgency levels in 1,416 visits was the following: 0.0% red (emergency); 5.9% orange (high urgency); 40.5% yellow (urgency); 50.6% green (low urgency); and 3.0% blue (no urgency). The percentage of patients who used two or more resources decreased from the orange level to the yellow, green, and blue levels (81%, 49%, 22%, and 2%, respectively, p<0.0001), as did the ED admission rate, ED length of stay, and hospitalization rate. The sensitivity to identify patients with high urgency level was 0.89 (confidence interval of 95% [95%CI] 0.78-0.95), and the undertriage rate was 7.4%. The inter-rater reliability in 191patients classified by two nurses was substantial (kw2=0.75; 95%CI 0.74-0.79).

Conclusions: The CLARIPED system showed good validity and substantial reliability for triage in a pediatric emergency department.

Citing Articles

Reliability and validity of Chengdu pediatric emergency triage criteria: case study of a single center in China.

Zhao Y, He L, Hu J, Zhao J, Yi X, Huang H BMC Pediatr. 2023; 23(1):246.

PMID: 37202797 PMC: 10197205. DOI: 10.1186/s12887-023-04072-4.

Validity of the Brazilian pediatric triage system CLARIPED at a secondary level of emergency care.

de Magalhaes-Barbosa M, de Camargo Traldi P, Raymundo C, da Cunha A, Prata-Barbosa A J Pediatr (Rio J). 2022; 99(3):247-253.

PMID: 36403739 PMC: 10202729. DOI: 10.1016/j.jped.2022.10.005.

Validity of the computerized version of the pediatric triage system CLARIPED for emergency care.

Traldi P, de Magalhaes-Barbosa M, Raymundo C, da Cunha A, Prata-Barbosa A J Pediatr (Rio J). 2021; 98(4):369-375.

PMID: 34571017 PMC: 9432060. DOI: 10.1016/j.jped.2021.08.004.

VALIDATION OF SCREENING SYSTEMS IN PEDIATRIC EMERGENCY.

Baracat E Rev Paul Pediatr. 2018; 36(4):386-387.

PMID: 30540105 PMC: 6322797. DOI: 10.1590/1984-0462/;2018;36;4;00018.

References

ROBERTSON M, Molyneux E . Description of cause of serious illness and outcome in patients identified using ETAT guidelines in urban Malawi. Arch Dis Child. 2001; 85(3):214-7. PMC: 1718902. DOI: 10.1136/adc.85.3.214. View

Durojaiye L, OMeara M . A study of triage of paediatric patients in Australia. Emerg Med (Fremantle). 2002; 14(1):67-76. DOI: 10.1046/j.1442-2026.2002.00261.x. View

Crellin D, Johnston L . Poor agreement in application of the Australasian Triage Scale to paediatric emergency department presentations. Contemp Nurse. 2003; 15(1-2):48-60. DOI: 10.5172/conu.15.1-2.48. View

Bergeron S, Gouin S, Bailey B, Amre D, Patel H . Agreement among pediatric health care professionals with the pediatric Canadian triage and acuity scale guidelines. Pediatr Emerg Care. 2004; 20(8):514-8. DOI: 10.1097/01.pec.0000136067.07081.ae. View

Considine J, LeVasseur S, Villanueva E . The Australasian Triage Scale: examining emergency department nurses' performance using computer and paper scenarios. Ann Emerg Med. 2004; 44(5):516-23. DOI: 10.1016/j.annemergmed.2004.04.007. View

Baumann M, Strout T . Evaluation of the Emergency Severity Index (version 3) triage algorithm in pediatric patients. Acad Emerg Med. 2005; 12(3):219-24. DOI: 10.1197/j.aem.2004.09.023. View

Gouin S, Gravel J, Amre D, Bergeron S . Evaluation of the Paediatric Canadian Triage and Acuity Scale in a pediatric ED. Am J Emerg Med. 2005; 23(3):243-7. DOI: 10.1016/j.ajem.2004.02.046. View

Roukema J, Steyerberg E, Van Meurs A, Ruige M, van der Lei J, Moll H . Validity of the Manchester Triage System in paediatric emergency care. Emerg Med J. 2006; 23(12):906-10. PMC: 2564249. DOI: 10.1136/emj.2006.038877. View

Hohenhaus S, Travers D, Mecham N . Pediatric triage: a review of emergency education literature. J Emerg Nurs. 2008; 34(4):308-13. DOI: 10.1016/j.jen.2007.06.022. View

10.

van Veen M, Steyerberg E, Ruige M, van Meurs A, Roukema J, van der Lei J . Manchester triage system in paediatric emergency care: prospective observational study. BMJ. 2008; 337:a1501. PMC: 2548283. DOI: 10.1136/bmj.a1501. View

11.

Ma W, Gafni A, Goldman R . Correlation of the Canadian Pediatric Emergency Triage and Acuity Scale to ED resource utilization. Am J Emerg Med. 2008; 26(8):893-7. DOI: 10.1016/j.ajem.2008.02.024. View

12.

Gravel J, Gouin S, Manzano S, Arsenault M, Amre D . Interrater agreement between nurses for the Pediatric Canadian Triage and Acuity Scale in a tertiary care center. Acad Emerg Med. 2008; 15(12):1262-7. DOI: 10.1111/j.1553-2712.2008.00268.x. View

13.

Gravel J, Manzano S, Arsenault M . Validity of the Canadian Paediatric Triage and Acuity Scale in a tertiary care hospital. CJEM. 2009; 11(1):23-8. DOI: 10.1017/s1481803500010885. View

14.

Travers D, Waller A, Katznelson J, Agans R . Reliability and validity of the emergency severity index for pediatric triage. Acad Emerg Med. 2009; 16(9):843-9. DOI: 10.1111/j.1553-2712.2009.00494.x. View

15.

Durani Y, Brecher D, Walmsley D, Attia M, Loiselle J . The Emergency Severity Index Version 4: reliability in pediatric patients. Pediatr Emerg Care. 2009; 25(11):751-3. View

16.

van Veen M, Teunen-van der Walle V, Steyerberg E, van Meurs A, Ruige M, Strout T . Repeatability of the Manchester Triage System for children. Emerg Med J. 2010; 27(7):512-6. DOI: 10.1136/emj.2009.077750. View

17.

Tang N, Stein J, Hsia R, Maselli J, Gonzales R . Trends and characteristics of US emergency department visits, 1997-2007. JAMA. 2010; 304(6):664-70. PMC: 3123697. DOI: 10.1001/jama.2010.1112. View

18.

Christ M, Grossmann F, Winter D, Bingisser R, Platz E . Modern triage in the emergency department. Dtsch Arztebl Int. 2011; 107(50):892-8. PMC: 3021905. DOI: 10.3238/arztebl.2010.0892. View

19.

Farrohknia N, Castren M, Ehrenberg A, Lind L, Oredsson S, Jonsson H . Emergency department triage scales and their components: a systematic review of the scientific evidence. Scand J Trauma Resusc Emerg Med. 2011; 19:42. PMC: 3150303. DOI: 10.1186/1757-7241-19-42. View

20.

Gravel J, Gouin S, Goldman R, Osmond M, Fitzpatrick E, Boutis K . The Canadian Triage and Acuity Scale for children: a prospective multicenter evaluation. Ann Emerg Med. 2012; 60(1):71-7.e3. DOI: 10.1016/j.annemergmed.2011.12.004. View