Risk classification of children and adolescents: priority of care in the emergency unit

Magalhães, Fernanda Jorge; Lima, Francisca Elisângela Teixeira; Barbosa, Lorena Pinheiro; Guimarães, Fernanda Jorge; Felipe, Gilvan Ferreira; Rolim, Karla Maria Carneiro; Lima, Essyo Pedro Moreira de

doi:10.1590/0034-7167-2019-0679

Brasil

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ORIGINAL ARTICLE • Rev. Bras. Enferm. 73 (suppl 4) • 2020 • https://doi.org/10.1590/0034-7167-2019-0679 linkcopy

Risk classification of children and adolescents: priority of care in the emergency unit

Clasificación de riesgo de niños y adolescentes: prioridad de la atención en la emergencia

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective: to evaluate the clinical conditions and the risk classification of children and adolescents treated in a hospital emergency, according to the Pediatric Risk Classification Protocol.

Method: cross-sectional study, with 200 participants, using an instrument based on the Pediatric Risk Classification Protocol and using odds ratio for the analysis.

Results: most participants were male patients in early childhood and who were or weren’t in daycare. As for clinical conditions, most showed changes in vital (24.5%) and respiratory (20.0%) signs, most patients (57.5%) did not present pain; 35.5% were classified as urgent and 45.0% as non-urgent. There was a greater chance of being classified as very urgent (orange) when compared to non-urgent (blue).

Conclusion: the protocol used contributed to an effective classification and was considered a valid and reliable health technology for determining the priority of care.

Descriptors: Child; Adolescent; Emergency; Risk; Clinical Protocols

Risk Classification Determinants	Orange		Yellow		Green		Blue		Total
Risk Classification Determinants	n	%	n	%	n	%	n	%	n	%
Changes in vital signs	4	8.2	23	46.9	19	38.8	3	6.1	49	24.5
Water-electrolyte imbalance	0	0	3	8.6	19	54.3	13	37.1	35	17.5
Respiratory alterations	0	0	5	12.5	21	52.5	14	35.0	40	20.0
Pain	0	0	0	0	1	50.0	1	50.0	2	1
Abdominal Pain	0	0	0	0	1	5.9	16	94.1	17	8.5
Headache	0	0	0	0	1	100	0	0	1	0.5
Burn and/or skin injury	0	0	2	6.3	5	15.6	25	78.1	32	16
Head trauma	0	0	0	0	1	100	0	0	1	0.5
Special situations	2	8.6	0	0	3	13.1	18	78.3	23	11.5
Total	6	3.0	33	16.5	71	35.5	90	45.0	200	100

Pain scale	n	%
No pain (zero)	115	57.5
Mild pain (1-3/10)	22	11.0
Moderate pain (4-7/10)	51	25.5
Severe pain (8-10/10)	12	6.0
Total	200	100

Clinical conditions/ Impairment Degree	Orange x Blue OR; (95%CI)		Yellow x Blue OR; (95%CI)		Green x Blue OR; (95%CI)
Changes in vital signs	57.3 (7.4 - 445.7)	1	65.9 (16.7 - 259.4)	1	8.8 (2.5 - 31.6)	1
Water-electrolyte imbalance	1.2 (1.1 - 1.3)	1	0.6 (0.2 - 2.2)	1	2.1 (0.96 - 4.6)	1
Respiratory alterations	1.2 (1.1 - 1.3)	1	0.9 (0.3 - 2.9)	1	2.2 (1.0 - 4.7)	1
Pain	1.0 (0.9 - 1.0)	1	1.0 (0.9 - 1.0)	1	3.8 (0.4 - 37.6)	1
Abdominal Pain	1.2 (1.1 - 1.3)	1	1.2 (1.1 - 1.3)	1	0.06 (0.08 - 0.5)	1
Headache	0	1	0	1	0.9 (0.96 - 1.0)	1
Burn and/or skin injury	1.4 (1.2 - 1.6)	1	0.08 (0.01 - 0.6)	1	0.1 (0.5 - 0.4)	1
Head trauma	0	1	0	1	0.98 (0.96 - 1.0)	1
Special situations	2.4 (0.4 - 14.7)	1	0.15 (0.2 - 1.2)	1	2.1 (0.6 - 0.7)	1

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