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

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 tri...

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Autores principales: de Magalhães-Barbosa, Maria Clara, de Camargo Traldi, Paula, Raymundo, Carlos Eduardo, da Cunha, Antonio José Ledo Alves, Prata-Barbosa, Arnaldo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10202729/
https://www.ncbi.nlm.nih.gov/pubmed/36403739
http://dx.doi.org/10.1016/j.jped.2022.10.005
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author de Magalhães-Barbosa, Maria Clara
de Camargo Traldi, Paula
Raymundo, Carlos Eduardo
da Cunha, Antonio José Ledo Alves
Prata-Barbosa, Arnaldo
author_facet de Magalhães-Barbosa, Maria Clara
de Camargo Traldi, Paula
Raymundo, Carlos Eduardo
da Cunha, Antonio José Ledo Alves
Prata-Barbosa, Arnaldo
author_sort de Magalhães-Barbosa, Maria Clara
collection PubMed
description 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.
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spelling pubmed-102027292023-05-24 Validity of the Brazilian pediatric triage system CLARIPED at a secondary level of emergency care de Magalhães-Barbosa, Maria Clara de Camargo Traldi, Paula Raymundo, Carlos Eduardo da Cunha, Antonio José Ledo Alves Prata-Barbosa, Arnaldo J Pediatr (Rio J) Original Article 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. Elsevier 2022-11-18 /pmc/articles/PMC10202729/ /pubmed/36403739 http://dx.doi.org/10.1016/j.jped.2022.10.005 Text en © 2022 Sociedade Brasileira de Pediatria. Published by Elsevier Editora Ltda. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
de Magalhães-Barbosa, Maria Clara
de Camargo Traldi, Paula
Raymundo, Carlos Eduardo
da Cunha, Antonio José Ledo Alves
Prata-Barbosa, Arnaldo
Validity of the Brazilian pediatric triage system CLARIPED at a secondary level of emergency care
title Validity of the Brazilian pediatric triage system CLARIPED at a secondary level of emergency care
title_full Validity of the Brazilian pediatric triage system CLARIPED at a secondary level of emergency care
title_fullStr Validity of the Brazilian pediatric triage system CLARIPED at a secondary level of emergency care
title_full_unstemmed Validity of the Brazilian pediatric triage system CLARIPED at a secondary level of emergency care
title_short Validity of the Brazilian pediatric triage system CLARIPED at a secondary level of emergency care
title_sort validity of the brazilian pediatric triage system clariped at a secondary level of emergency care
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10202729/
https://www.ncbi.nlm.nih.gov/pubmed/36403739
http://dx.doi.org/10.1016/j.jped.2022.10.005
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