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CLARIPED: a new tool for risk classification in pediatric emergencies

OBJECTIVE: To present a new pediatric risk classification tool, CLARIPED, and describe its development steps. METHODS: Development steps: (i) first round of discussion among experts, first prototype; (ii) pre-test of reliability, 36 hypothetical cases; (iii) second round of discussion to perform adj...

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Detalles Bibliográficos
Autores principales: de Magalhães-Barbosa, Maria Clara, Prata-Barbosa, Arnaldo, da Cunha, Antonio José Ledo Alves, Lopes, Cláudia de Souza
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Sociedade de Pediatria de São Paulo 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5178109/
https://www.ncbi.nlm.nih.gov/pubmed/27083070
http://dx.doi.org/10.1016/j.rppede.2016.02.002
Descripción
Sumario:OBJECTIVE: To present a new pediatric risk classification tool, CLARIPED, and describe its development steps. METHODS: Development steps: (i) first round of discussion among experts, first prototype; (ii) pre-test of reliability, 36 hypothetical cases; (iii) second round of discussion to perform adjustments; (iv) team training; (v) pre-test with patients in real time; (vi) third round of discussion to perform new adjustments; (vii) final pre-test of validity (20% of medical treatments in five days). RESULTS: CLARIPED features five urgency categories: Red (Emergency), Orange (very urgent), Yellow (urgent), Green (little urgent) and Blue (not urgent). The first classification step includes the measurement of four vital signs (VIPE score); the second step consists in the urgency discrimination assessment. Each step results in assigning a color, selecting the most urgent one for the final classification. Each color corresponds to a maximum waiting time for medical care and referral to the most appropriate physical area for the patient's clinical condition. The interobserver agreement was substantial (kappa=0.79) and the final pre-test, with 82 medical treatments, showed good correlation between the proportion of patients in each urgency category and the number of used resources (p<0.001). CONCLUSIONS: CLARIPED is an objective and easy-to-use tool for simple risk classification, of which pre-tests suggest good reliability and validity. Larger-scale studies on its validity and reliability in different health contexts are ongoing and can contribute to the implementation of a nationwide pediatric risk classification system.