A pediatric triage system developed over a decade ago by researchers from the D’Or Institute for Research and Education (IDOR) continues to demonstrate its effectiveness in improving patient flow and risk classification in pediatric emergency centers. A study published in the Jornal de Pediatria, highlights the system’s ability to accurately classify over 24,000 pediatric cases in a private hospital in São Paulo between 2018 and 2019. 

Understanding Clariped 

Pediatric emergency departments face unique challenges. Catering to infants, children, and adolescents means dealing with patients who often cannot articulate their symptoms, making it harder to prioritize cases and determine appropriate wait times. In this context, triage plays a crucial role in ensuring quick and efficient care—especially in countries like Brazil, which face healthcare disparities and resource constraints.

“The pediatric triage systems used in other countries—many adapted from adult-focused models—were either too complex for practical use or failed to address the specific needs of pediatric patients in our setting,” explains Dr. Maria Clara de Magalhães-Barbosa, a researcher at IDOR and lead author of the study. 

With these challenges in mind, IDOR pediatricians and researchers partnered with the Institute of Social Medicine at Rio de Janeiro State University (IMS/UERJ) in 2012 to create a simple yet comprehensive triage tool tailored for pediatric emergencies. The result was Clariped (short for “Pediatric Risk Classification”), a system designed to streamline the triage process while ensuring patient safety. 

Clariped operates within a 2-to-5-minute timeframe, using clinical criteria specific to each age group. The system assigns a risk level to each patient, linking it to a maximum wait time for medical attention. Initially paper-based, the tool is now in its third digital iteration and has been validated through numerous studies for its reliability and positive impact on pediatric emergency care.

Evaluating Its Performance 

While Clariped’s performance had already been validated in tertiary care centers in Rio de Janeiro, researchers sought to examine its success in other cities and healthcare infrastructures. To do so, they conducted a prospective observational study from September 2018 to August 2019 at a private secondary pediatric care center in São Paulo. Secondary care centers typically have more resources than primary care units but fewer than tertiary hospitals, which are equipped for complex procedures. 

The study analyzed 24,338 pediatric cases, involving patients aged 0 to 18 years. Clariped categorized these cases into five risk levels: 

🔴 RED – Emergency: 0.02%
🟠 ORANGE –  Very urgent: 0.9%
🟡 YELLOW –  Urgent: 23.5%
🟢 GREEN –  Less urgent: 47.9%
🔵 BLUE – Non-urgent: 27.7% 

Clinical outcomes aligned with the triage levels, with patients classified as more urgent (red, orange, and yellow) showing a higher likelihood of hospitalization and greater use of hospital resources. The tool demonstrated high sensitivity in distinguishing critical cases from less urgent ones, achieving strong predictive value and a low under-triage rate. 

A Tool for the Future 

Clariped has proven to be quick, straightforward, and widely accepted by healthcare professionals, ensuring smooth patient flow. During the study, over 85% of emergency visits were successfully classified using Clariped, showcasing excellent adherence and a streamlined triage process. 

Now used in pediatric emergency departments across multiple hospitals in the Rede D’Or network, Clariped continues to evolve, with ongoing studies aiming to further refine its validity and adaptability. Efforts are underway to expand its adoption nationwide, which could pave the way for standardized pediatric emergency care across Brazil. 

Written by Maria Eduarda Ledo de Abreu.