Pediatric emergency assessment tool (PEAT): A risk-adjustment measure for pediatric emergency patients

Objective: To develop a multivariable model predicting the level of care re quired by pediatric patients for use as a risk-adjustment tool in the evalu ation of emergency medical services for children. Methods: A random 10% sam ple of records of all visits over a 12-month period to a suburban, universi ty-affiliated pediatric emergency department (PED) was selected and abstrac ted. The outcome variable, level of care received, was categorized in three levels: routine care only (R); diagnostic or therapeutic procedures perfor med in the ED but patient not; admitted (EDT); and admission to hospital (A DM). Predictor variables included information routinely elicited and record ed at the time of triage. Using multinomial logistic regression, a predicti ve model was derived from a subset of 70% of the selected visits, and was v alidated in the remaining 30%. Results: The total sample included 2,287 vis its. The overall rate of each outcome was R-37%, EDT-53%, and ADM-10%. The final regression model included the following predictors significantly asso ciated with the outcome: age, past medical history, temperature, abnormal r espiratory rate or pulse oximetry in triage, chief complaint, and triage le vel (model likelihood ratio chi-square, 14 df = 332, p < 0.00001, R-2 = 0.1 4). The number of outcomes was well predicted by the model in both subsampl es. Analysis of variance showed a significant association between Pediatric Emergency Assessment Tool (PEAT) score (weighted sum of the predicted prob abilities of EDT and ADM) and both ED charges and time spent in the ED (p < 0.001). Conclusions: A model based on easily and routinely measured variab les can accurately predict the level of care rendered in the PED. The predi cted probabilities from such a model correlate well with other outcomes of care and may be useful in adjusting for differences in risk when evaluating quality of care.