María Noellia García Hernández, Armando Aguirre-Jaime
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引用次数: 0
Abstract
Objective: Measure the validity, reliability and consistency of two alternative diagnostic systems, Nurse Pediatric Emergency Assessment for Primary Care system (VEUPAP) and web_e-PAT®, using expert pediatricians judgment as a gold standard.
Material and methods: Random sample of 300 children aged 0-14 years treated at the Pediatric Urgency Service Dr. Jaime Chaves in Santa Cruz de Tenerife between March 2009 and March 2010. Demographics data, time, presentation of complications and referrals to high, triage results according VEUPAP and web_e-PAT®, medical discharge and interview results to escort the child report, were registered. Sensitivity, specificity, frequency of false positive and negative predictive values of results, their concordance with the gold standard, and reliability of both methods, were estimated.
Results: VEUPAP offers better values that web_e-PAT® with sensitivity 94% (95% Cl: 91-97%) vs. 36% (95% Cl: 31-41%), specificity 93(90-96)% vs. 87(83-91)%, positive predictive value of 89 (86-92)% vs. 63(58-68)%, and negative 96(94-98)% vs. 69(64-74)%, yield a4 vs. 3 times more, according to expert pediatrician 84(80-88)5 vs. 12(9-15)% reliability and 64(59-69)% vs. 59(54-63)% according to the weighted kappa Cohen (p < 0.001). Three levels lower and upper of triage discrepancies do not occur with any of the systems, the discrepancy in lower and upper triage at 2 levels do not occur with VEUPAP and is 14% and 4% respectively with web_e-PAT® (p = 0.032-0.045). Most of the discrepancies occur with triage level 1 being for VEUPAP 2-8% and 10-36% for web_e-PAT® (p < 0.001). The time consumption for both systems reached significance only for priority level 3: 4 (2-7) vs. 4 minutes (2-14), respectively (p = 0.044).
Conclusions: VEUPAP is a homogeneous and systematic objective tool. The characteristics of accuracy, validity, accuracy, reliability, usefulness and ease of use make it suitable to assessment and classification pediatric patients in primary care emergency.
目的:以儿科专家的判断为金标准，衡量两种替代诊断系统——初级保健护士儿科急诊评估系统(VEUPAP)和web_e-PAT®的效度、信度和一致性。材料与方法:2009年3月至2010年3月，随机抽取300名0-14岁儿童在圣克鲁斯德特内里费儿科急诊中心接受Jaime Chaves医生治疗。登记人口统计数据、时间、并发症的出现和转诊情况、根据VEUPAP和web_e-PAT®进行的分诊结果、医疗出院和陪同儿童报告的访谈结果。评估了两种方法的灵敏度、特异性、假阳性和阴性预测值的频率、与金标准的一致性以及可靠性。结果:VEUPAP的敏感性为94% (95% Cl: 91-97%) vs. 36% (95% Cl: 31-41%)，特异性为93(90-96)% vs. 87(83-91)%，阳性预测值为89 (86-92)% vs. 63(58-68)%，阴性预测值为96(94-98)% vs. 69(64-74)%，产出率为a4 vs. 3倍，根据加权kappa Cohen (p < 0.001)，专家儿科医生认为可靠性为84(80-88)5 vs. 12(9-15)%，可靠性为64(59-69)% vs. 59(54-63)%。任何系统都没有出现三级以上和三级以下的分诊差异，VEUPAP没有出现二级以上和二级以下的分诊差异，web_e-PAT®分别为14%和4% (p = 0.032-0.045)。大多数差异发生在分诊等级1中，VEUPAP为2-8%，web_e-PAT为10-36% (p < 0.001)。两个系统的时间消耗只有在优先级级别3时才具有显著性:分别为4(2-7)和4分钟(2-14)(p = 0.044)。结论:VEUPAP是一种均匀、系统的客观工具。该方法具有准确性、效度、准确性、信度、有用性和易用性等特点，适用于初级保健急诊儿科患者的评估和分类。
期刊介绍：
Revista ROL de Enfermería es una publicación abierta a todos aquellos trabajos que tengan como objetivo contribuir a la difusión del conocimiento científico en la atención de enfermería en sus diferentes ámbitos de actuación. Revista ROL de Enfermería considerará para su publicación los trabajos que dentro del marco general de las ciencias de la salud, tengan interés por los conocimientos e informaciones que aporten para contribuir al desarrollo y a la formación continuada de los profesionales de enfermería.
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