CLARIPED: a new tool for risk classification in pediatric emergencies

Abstract

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.

Validity of the computerized version of the pediatric triage system CLARIPED for emergency care

“… 2 Currently, some validated pediatric triage systems are originating in different countries, such as the Manchester Triage System (MTS, United Kingdom), the Canadian Triage and Acuity Scale (CTAS, Canada), the Emergency Severity Index (ESI, United States of America) and the Classification of Risk in Pediatrics (CLARIPED, Brazil). 3 , 4 However, the validity of these systems varies according to the patient load, the severity of illness case mix, available infrastructure, and available resources. 5 The greater the socioeconomic and epidemiological diversity, the greater the difference in the performance of these tools.…”

Pediatric emergency triage systems

“…Children bring some challenges to the triage systems, since they may exhibit a variation of vital signs depending on their age group and may also present nonspecific clinical symptoms, besides requiring the assistance of an interlocutor during care. 49 The implementation of a pediatric triage system in the ED is divided into two very imperative phases: planning and transition. Both phases require the engagement of all involved parties, including administrative, information technology, medical, and multiprofessional staff.…”

A Review of Various Methods of Management of Risk in the Field of Emergency Medicine

“…In emergencies based on the overall health condition of patients, various happened disorders at different levels could be specified to be treated in the ED or other medical settings. In this regard, based on the most recent studies carried out recently, as could be seen from the Table 2 various disorders are reported to be the most common damaging ones which must be treated immediately at emergency departments [25]. One of the main kinds of pain that are presented among most patients at the emergency departments is chest pain which could be one of the major critical risk-full problems.…”