title: 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.
authors.affiliation: Instituto D'Or de Pesquisa e Ensino (Idor), Rio de Janeiro, RJ, Brasil. Electronic address: mariaclaramb@globo.com.
authors.forename: Maria Clara de
authors.initials: MC
authors.lastname: Magalhães-Barbosa
authors.affiliation: Instituto D'Or de Pesquisa e Ensino (Idor), Rio de Janeiro, RJ, Brasil.
authors.forename: Arnaldo
authors.initials: A
authors.lastname: Prata-Barbosa
authors.affiliation: Departamento de Pediatria, Faculdade de Medicina, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brasil.
authors.forename: Antonio José Ledo
authors.initials: AJ
authors.lastname: Alves da Cunha
authors.affiliation: Instituto de Medicina Social (IMS), Universidade do Estado do Rio de Janeiro (Uerj), Rio de Janeiro, RJ, Brasil.
authors.forename: Cláudia de Souza
authors.initials: Cde S
authors.lastname: Lopes
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004630:Emergencies / Q000145:classification*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*
keywords: Emergency medical services; Pediatria; Pediatrics; Serviços médicos de emergência; Triage; Triagem