InfoKids+: A Validation Study of a Pediatric Acuity Risk Stratification Algorithm

Area of Science:

• Pediatric Emergency Medicine
• Health Informatics
• Clinical Decision Support Systems

Background:

• Pediatric emergency departments (PEDs) face challenges in efficiently and accurately stratifying patient acuity.
• Electronic risk stratification algorithms (eRSAs) offer potential solutions but require thorough validation.
• The InfoKids+ eRSA was developed based on the InfoKids parental guidance application.

Purpose of the Study:

• To prospectively validate the performance of the InfoKids+ pediatric acuity electronic risk stratification algorithm (eRSA).
• To compare the InfoKids+ eRSA's triage accuracy against a standard nurse-based triage system (nbTS).

Main Methods:

• A prospective validation study was conducted in a Swiss university hospital's PED.
• 1990 participants' acuity levels were assessed using InfoKids+ and compared to nbTS.
• Primary outcomes included level of agreement and rate of alignment between the two triage methods.

Main Results:

• InfoKids+ demonstrated slight agreement with the nbTS (κlw=0.08).
• Significant discrepancies were observed in triage urgency: InfoKids+ classified 89% as urgent vs. 41% by nbTS (P<.001).
• Alignment with the reference standard occurred in only 45% of cases, with 50% over-referrals and 5% under-referrals.

Conclusions:

• The InfoKids+ eRSA exhibited notable discrepancies when compared to conventional nurse-based triage.
• The findings underscore the necessity for rigorous validation of eRSAs for accuracy and patient safety.
• Ensuring the safety and efficacy of algorithmic triage tools is critical to prevent harm and optimize resource allocation.