VALIDATION OF THE PEDIATRIC APPROPRIATENESS EVALUATION PROTOCOL IN BRITISH PRACTICE

The reliability and validity of the North American paediatric appropri ateness evaluation protocol (PAEP) for use in paediatric practice in B ritain was tested. The protocol was applied to 418 case records of con secutive emergency admissions to three Yorkshire district general hosp itals. The PAEP ratings were then compared with a clinical consensus o pinion obtained from two expert panels. Altogether 32% of the admissio ns were rated inappropriate by the PAEP and 36% by the panels. Validit y of the PAEP, as measured by agreement beyond chance with the expert panel rating, was only moderate with a kappa of 0.29 (95% confidence i nterval 0.11 to 0.47). The PAEP has limited validity for evaluating Br itish paediatric practice. Utilisation review instruments developed in differing clinical cultures should be used with caution until shown t o be valid for the practice setting under review.