Construção e validação de um guia abreviado do protocolo de acolhimento com classificação de risco em pediatria

Abstract

The host with the risk rating (ACCR) to pediatric patients in emergency departments is a strategy adopted by the Ministry of Health to organize the service in accordance with the degree of complexity. The role of nurses in this sector is to accept the patient, identify emergencies and emergencies based on the evaluation criteria established by protocols and give priority to serious cases. However, the conflicting environment of the emergency services more difficult for nurses use protocols, evaluation of the child. The purpose of this study is to obtain a tool able to accurately assess the risk of patients quickly and reliably, to be used as an aid to the protocols. He had intended to construct and validate an abbreviated guide ACCR pediatric protocol in Fortaleza-CE. This is a research methodology developed in two stages: the instrument and content validation. The first abbreviated version of the guide was developed in light of the contents of the protocol in pediatric ACCR of Fortaleza, and followed the structural orientation of the instrument Paediatric Triage Tool (abridged version of scale Australian pediatric screening). Was assessed by nine judges, four teachers / researchers expert in psychometrics, content and so-called judges, five nurses with clinical experience in risk rating - technical judges, selected by experts classification system adopted. We used the strategy of "Subject Search" in the Platform Lattes for selection of judges and content, it was considered the social networks through sampling network technicians to select the judges. For validation of appearance, the court ruled the 25 (100%) items, clear and understandable by the concordance of 77.8%. We also analyzed the relevance of the items (Complaints and Major Signs and Symptoms) regarding classification of risk in the colors red, orange, yellow, green and blue, and considered to be the content of 23 (92%) of 25 items pertaining to related risk rating. Regarding the adequacy of risk indicators (airway/breathing, circulation/hemodynamics, level of consciousness, pain, elimination/hydration) the content of items 5 (100%) say they are relevant in the opinion of the judges (N=9; 100%), characterizing the risk indicators as appropriate to the contents of the "main complaints" and "Signs and Symptoms" related. For the content validation of the relevance of short items in the guide, 17 (68%) were considered relevant, and 8 (32%) not relevant by judges. However, it was deemed appropriate to carry out assessment of the relevance of items and the instrument as a whole, by applying the calculation of the Content Validity Index (CVI) CVI and obtained equal to 0.98. And there is therefore no need to remove the 8 items with less than 80% agreement. In the second abbreviated version of the Guide, there were changes to the layout, structure and content of items, suggestion of judges. It was concluded, they earned a valuable instrument that can accurately measure the degree of clinical complexity of the child, and reliable for us in providing emergency services, nurses, reduce the evaluation time of the child and reduce the chances of error.