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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.
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OBJECTIVE: To determine the rate of inappropriate antibiotic prescription and to describe the types of antibiotics prescribed by health workers to children with acute respiratory infection (ARI). DESIGN: Cross-sectional survey conducted in 6 state capitals of Brazil. METHODS: A representative sample of facilities was selected in each state using a cluster sampling method based on the mean number of visits of children less than 5 years of age. In each facility, consultations were observed and children were reassessed following standard guidelines. Health worker s diagnosis and treatment were compared with a gold standard and inappropriate antibiotic prescriptions noted. RESULTS: 1565 children with ARI from 156 health facilities (73% health centers) were included in study. Most children had a common cold (77.5%). Antibiotics were inappropriately prescribed in 9.2% (95% CI: 7.8, 10.7) of ARI cases (range: 2.8% to 25%). Most frequently prescribed antibiotics were those recommended by the ARI Program. Seventy-six percent of health workers explained to guardians how to use antibiotics at home and 3.9% demonstrated the first dose. Antibiotics were available in 84% of health facilities. CONCLUSION: Inappropriate prescription of antibiotics varied geographically in Brazil. More training and supervision is needed to decrease it.