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[Inappropriate utilization of pediatric hospitalization. Validation of the pediatric appropriateness evaluation
C Casanova Matutano1, P Gascón Romero, F Calvo Rigual
1Servicio de Pediatría, Hospital de Sagunto, Puerto de Sagunto, Valencia, 46520, España.
Insights
The Spanish Pediatric Appropriateness Evaluation Protocol (PAEP) demonstrates high reliability and moderate validity. This validated tool is effective for assessing the appropriate utilization of pediatric hospitalizations.
Area of Science:
- Pediatric healthcare quality assessment
- Clinical protocol validation
- Health services research
Background:
- Assessing the appropriateness of pediatric hospitalizations is crucial for resource optimization and patient care.
- Existing evaluation protocols require validation for specific linguistic and cultural contexts.
Purpose of the Study:
- To validate the Spanish version of the Pediatric Appropriateness Evaluation Protocol (PAEP).
- To establish the reliability and validity of the PAEP for use in Spanish-speaking pediatric populations.
Main Methods:
- The Spanish PAEP was applied by two independent reviewers to 104 pediatric patient records (6 months to 14 years).
- Interobserver reliability was assessed using overall agreement (IO), specific agreement (IE), and Cohen's kappa (κ).
- Criterion validity was evaluated by comparing reviewer results against expert pediatrician judgment, calculating sensitivity, specificity, and predictive values.
Main Results:
- High interobserver reliability was found for admissions (IO: 94.2%, κ: 0.77) and days of care (IO: 96.2%, κ: 0.83).
- Moderate validity was observed for admissions (IO: 92.35%, κ: 0.70) and days of care (IO: 90.4%, κ: 0.68).
- The PAEP demonstrated good predictive values, with sensitivity and specificity for admissions at 80% and 94%, respectively.
Conclusions:
- The Spanish PAEP exhibits high reliability and moderate validity when compared to clinical judgment.
- The protocol possesses good predictive value, making it a useful instrument for evaluating the appropriate use of pediatric hospitalizations.
Objective:
To validate the Spanish version of the Pediatric Appropriateness Evaluation Protocol (PAEP).
Methods:
The protocol was applied by two independent reviewers to a sample of 104 clinical records of pediatric patients (age 6 months to 14 years) admitted to a general hospital in the Valentian Community. Reliability was tested by comparing their results. Validity was tested by comparing the results of one reviewer with the judgment of three pediatricians. The following measures were calculated: overall agreement (IO), specific agreement (IE), Cohen's κ, inappropriate use ratio, and, to evaluate the predictive value, sensitivity, specificity and positive and negative predictive value.
Results:
Interobserver reliability was high: the IO for admissions was 94.2% and 96.2% for days of care. The IE was 66.7% and 75% respectively, and κ showed values of excellent agreement: 0.77 (95% CI 0.59-0.94) for admissions and 0.83 (95% CI 0.68-0.99) for days of care. Validity was moderate: the IO for admissions was 92.35, and 90.4% for days of care. The IE was 60% and 58.3% respectively, and κ showed values of good agreement: 0.70 (95% CI 0.51-0.90) for admissions and 0.68 (95% CI 0.50-0.86) for days of care. Inappropriate use ratio was 1.13 for admissions and 0.73 for days of care. The sensitivity and specificity were high for admissions (80% and 94% respectively), while sensitivity was lower for days of care (64% and 98%). Regarding the prevalence of inappropriate use of this study, the positive predictive value ranged between 71% and 88%, and the negative predictive value ranged between 97% and 91%.
Conclusions:
PAEP has a high reliability, moderate validity and good predictive value face to clinical judgment, and it is a useful instrument for assessing the inappropriate utilization of pediatric hospitalization.
