RevPaulPediatr.2016;34(3):249---250
REVISTA
PAULISTA
DE
PEDIATRIA
www.rpped.com.br
EDITORIAL
Triage
and
risk
classification
protocols
in
Pediatric
emergency
Protocolos
de
triagem
e
classificac
¸ão
de
risco
em
emergência
pediátrica
Emílio
Carlos
Elias
Baracat
DepartamentodePediatria,FaculdadedeCiênciasMédicas,UniversidadeEstadualdeCampinas(Unicamp),Campinas,SP,Brazil
Theuseoftriageprotocolsinurgencyandemergency ser-vicesisakeystrategyfortherapidtreatmentofthepatient withsevereclinical condition. Theurgency categorization and waitingtime definitionareconsidered quality indica-torsinpatientcare,especiallyinsituationswhenthereisa largevolumeofpatients.
Emergency service triage is a relatively recent phe-nomenon,introducedin1950intheUnitedStates.Several systems have been developed since then to guide health teamstoperformthecorrectdecision-making.1
Thediscussionintheliteratureonriskclassificationtools
in Pediatric emergency is an ongoing one and available
toolsareappliedindifferentepidemiologicalsituations.The majorityoftriagescalesarestratifiedintofiveurgency lev-elsorcategories.The mostoftenusedscalesin Pediatrics arethePaedCTAS(ThePaediatricCanadianTriageandAcuity Scale),MTS(TheManchesterTriageSystem),ESI(Emergency SeverityIndex)and ATS(Australian TriageScale), all
vali-dated withthe inclusion of basic parameters of Pediatric
response in acuteinjuries. Among these parameters, the
patient’s vital data, such as respiratory rate, heart rate,
levelofconsciousness,bodytemperatureandoxygen
satu-ration,inadditiontothemaincomplaint,comprisethemain components.1---3ThePaedCTAS,MTSandESIsystemscontain
specific partsfor the Pediatric population.2,4,5 In a study
byvanVeen&Moll,withaliteraturereview,theMTSand
E-mail:ebaracat@fcm.unicamp.br
PaedCTASsystemsshowedbetterreliabilityandefficacyfor useinPediatricemergency.6
For its validation, it is essential for the tool to be
reliable and safe.7 That is determined by an agreement
betweenobservers(evaluationofthesamepatientby
dif-ferentprofessionals) andin the same observer(the same
patientorscenarioassessedatdifferenttimes)(Kappa
coef-ficient).Thismeasureofagreementhasamaximum value
of1 (total agreement)and can beclose tozero, indicat-ingnoagreement.8Instudiesevaluatingtheuseofseverity
assessment scales, it is essential to identify and correct interobservervariabilityinsearchfor ahighKappa coeffi-cientbeforefielduse.
In this issue of Revista Paulista de Pediatria, Barbosa
andcolleagues propose the implementationof a newrisk
classificationtool in Pediatric emergency --- CLARIPED, to be used in the national territory.9 For that purpose, the
studyauthorscarefullyfollowedtheriskclassificationscale validationsteps,withpriordiscussionwithagroupof spe-cialists, staff training, pre-testing, adjustment and final testing,obtainingahighKappacoefficient(0.79).Risk clas-sificationintofivecategoriesisproposed,usingthemarkers of vital signs, reason for consultation and overall assess-mentofgeneralhealthstatus,pain,fever,ageandreturn
totheservice.Theresultsshowedagreementbetweenthe
riskclassificationandtheuseofdiagnosticandtherapeutic resources.
The comparison of the study results with previously
validated tools in the literature and the increase of its
http://dx.doi.org/10.1016/j.rppede.2016.06.005
250 BaracatEC
large-scale application in different Pediatric emergency
contextscanreinforcetheproposal,aswellasitsreliable andsafeinclusion.
Funding
Thisstudydidnotreceivefunding.
Conflicts
of
interest
Theauthordeclaresnoconflictsofinterest.
References
1.FarrohkniaN,CastrénM,EhrenbergA,LindL,OredssonS, Jon-sson H, et al. Emergency department triagescales and their components: a systematic review of the scientific evidence. ScandJTraumaResuscEmergMed.2011;30:19---42.
2.vanVeenM,SteyerbergEW,RuigeM,vanMeursAH,Roukema J,vanderLeiJ,etal.Manchestertriagesysteminpaediatric
emergency care: prospective observational study. BMJ. 2008;337:a1501.
3.EbrahimiM,HeydariA,MazlomR,MirhaghiA.Thereliabilityof theAustralasianTriage Scale:a meta-analysis.WorldJEmerg Med.2015;6:94---9.
4.WarrenDW,JarvisA,LeBlancL,GravelJ,CTASNational Work-ingGroup,CanadianAssociationofEmergencyPhysicians,etal. Revisions to the Canadian Triage and Acuity Scale paediatric guidelines(PaedCTAS).CJEM.2008;10:224---43.
5.GreenNA,DuraniY,BrecherD,DePieroA,LoiselleJ,AttiaM. Emergency Severity Indexversion 4: avalid and reliable tool inpediatricemergencydepartmenttriage.PediatrEmergCare. 2012;28:753---7.
6.vanVeenM,MollHA.Reliabilityandvalidityoftriagesystemsin paediatricemergencycare.ScandJTraumaResuscEmergMed. 2009;17:38.
7.MollHA.Challengesinthevalidationoftriagesystemsat emer-gencydepartments.JClinEpidemiol.2010;63:384---8.
8.FleissJL.Statisticalmethodsforratesandproportions.3rded. NewYork:JohnWiley;2003.
