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Validity of the computerized version of the pediatric triage system CLARIPED for emergency care
Paula de Carmago Traldi1, Maria Clara de Magalhães-Barbosa2, Carlos Eduardo Raymundo2
1Universidade Federal do Rio de Janeiro (UFRJ), Instituto de Puericultura e Pediatria Martagão Gesteira (IPPMG), Rio de Janeiro, RJ, Brazil; Instituto D'Or de Pesquisa e Ensino (IDOR), Rio de Janeiro, RJ, Brazil.
Insights
The computerized CLARIPED pediatric triage system is valid and safe, demonstrating good sensitivity and a low undertriage rate. It effectively correlates urgency levels with patient outcomes in emergency departments.
Area of Science:
- Pediatric Emergency Medicine
- Health Informatics
- Clinical Triage Systems
Background:
- Pediatric triage systems are crucial for prioritizing care in emergency departments.
- Evaluating the validity of computerized systems like CLARIPED is essential for improving patient safety and resource allocation.
Purpose of the Study:
- To assess the construct validity and accuracy of the computerized pediatric triage system, CLARIPED.
- To determine the correlation between CLARIPED urgency levels and key patient outcomes.
Main Methods:
- A prospective, observational study was conducted in a tertiary emergency department over one year.
- 19,122 pediatric patients (0-18 years) underwent computerized triage using CLARIPED.
- Construct validity was evaluated by correlating triage urgency with outcomes like hospital admission, ED observation, resource utilization, and length of stay.
Main Results:
- Urgency levels significantly correlated with increased hospital admission, longer ED observation, higher resource use, and extended ED length of stay.
- The system demonstrated a sensitivity of 0.82 and a specificity of 0.62 for identifying urgency.
- Undertriage rate was 18.41%, and overtriage rate was 4.28%.
Conclusions:
- The computerized CLARIPED system is a valid and safe tool for pediatric triage.
- It shows a significant association with clinical outcomes and possesses good sensitivity with a low undertriage rate.
Objective:
To evaluate the validity of the computerized version of the pediatric triage system CLARIPED.
Methods:
Prospective, observational study in a tertiary emergency department (ED) from Jan-2018 to Jan-2019. A convenience sample of patients aged 0-18 years who had computerized triage and outcome variables registered. Construct validity was assessed through the association between urgency levels and patient outcomes. Sensitivity, specificity, positive and negative predictive values (PPV and NPV), undertriage, and overtriage rates were assessed.
Results:
19,122 of 38,321 visits were analyzed. The urgency levels were: RED (emergency) 0.02%, ORANGE (high urgency) 3.21%, YELLOW (urgency) 35.69%, GREEN (low urgency) 58.46%, and BLUE (no urgency) 2.62%. The following outcomes increased according to the increase in the level of urgency: hospital admission (0.4%, 0.6%, 3.1%, 11.9% and 25%), stay in the ED observation room (2.8%, 4.7%, 15.9%, 40.4%, 50%), ≥ 2 diagnostic or therapeutic resources (7.8%, 16.5%, 33.7%, 60.6%, 75%), and ED length of stay in minutes (18, 24, 67, 120, 260). The odds of using ≥ 2 resources or being hospitalized were significantly greater in the most urgent patients (Red, Orange, and Yellow) compared to the least urgent (Green and Blue): OR 7.88 (95%CI: 5.35-11.6) and OR 2.85 (95%CI: 2.63-3.09), respectively. The sensitivity to identify urgency was 0.82 (95%CI: 0.77-0.85); specificity, 0.62 (95%CI: 0.61-0.6; NPV, 0.99 (95%CI: 0.99-1.00); overtriage rate, 4.28% and undertriage, 18.41%.
Conclusion:
The computerized version of CLARIPED is a valid and safe pediatric triage system, with a significant correlation with clinical outcomes, good sensitivity, and low undertriage rate.
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