Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2023 May-Jun;99(3):247-253.
doi: 10.1016/j.jped.2022.10.005. Epub 2022 Nov 18.

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

Maria Clara de Magalhães-Barbosa  1 , Paula de Camargo Traldi  2 , Carlos Eduardo Raymundo  1 , Antonio José Ledo Alves da Cunha  2 , Arnaldo Prata-Barbosa  3
Affiliations
Observational Study

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

Maria Clara de Magalhães-Barbosa et al. J Pediatr (Rio J). 2023 May-Jun.

Abstract

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.

Keywords: Emergency care; Pediatric; Triage; Validity.

PubMed Disclaimer

Conflict of interest statement

Conflicts of interest The authors declare no conflicts of interest.

References

    1. Farrohknia N., Castrén M., Ehrenberg A., Lind L., Oredsson S., Jonsson H., et al. Emergency department triage scales and their components: a systematic review of the scientific evidence. Scand J Trauma Resusc Emerg Med. 2011;19:42. - PMC - PubMed
    1. Hansoti B., Jenson A., Keefe D., de Ramirez S.S., Anest T., Twomey M., et al. Reliability and validity of pediatric triage tools evaluated in Low resource settings: a systematic review. BMC Pediatr. 2017;17:37. - PMC - PubMed
    1. Hohenhaus S.M., Travers D., Mecham N. Pediatric triage: a review of emergency education literature. J Emerg Nurs. 2008;34:308–313. - PubMed
    1. Christ M., Grossmann F., Winter D., Bingisser R., Platz E. Modern triage in the emergency department. Dtsch Arztebl Int. 2010;107:892–898. - PMC - PubMed
    1. Magalhães-Barbosa M.C., Robaina J.R., Prata-Barbosa A., Lopes C.S. Validity of triage systems for paediatric emergency care: a systematic review. Emerg Med J. 2017;34:711–719. - PubMed

Publication types