InfoKids+: A Validation Study of a Pediatric Acuity Risk Stratification Algorithm

Abstract

Objective

To prospectively validate InfoKids+, a pediatric acuity electronic risk stratification algorithm (eRSA), against a nurse-based triage standard (nbTS).

Participants and Methods

We conducted a prospective validation study in a Swiss university hospital pediatric emergency department to assess the performance of a pediatric acuity eRSA, InfoKids+, on the basis of a well-established parental guidance application, InfoKids. Participants completed the eRSA once seated in a consultation booth. We compared the acuity levels from InfoKids+ (urgent, <4 hours; nonurgent, <24 hours; and no emergency, ≥24 hours) against an nbTS. The primary outcome was the level of agreement and rate of alignment between InfoKids+ and the reference standard.

Results

We included 1990 participants from June 3, 2020, through January 31, 2022. InfoKids+ showed a slight level of agreement with the nbTS (κ_lw=0.08; 95% CI, 0.06-0.10). InfoKids+ triaged 1762 (89%) cases as urgent (<4 hours), 106 (5%) as nonurgent (≤24 hours), and 122 (6%) as no emergency (≥24 hours), compared with 810 (41%), 843 (42%), and 337 (17%) triages by the nbTS, respectively (P<.001). InfoKids+ acuity level aligned with the reference standard in 888 (45%) cases, whereas it overreferred and underreferred in 999 (50%) and 103 (5%) cases, respectively (P<.001).

Conclusion

In summary, our study uncovered notable discrepancies between the InfoKids+ algorithmic triage and conventional nurse-based triage. Our results highlight the critical need for rigorous validation of such tools for accuracy and safety before public release to ensure these tools are beneficial and do not inadvertently cause harm or misallocation of resources.