InfoKids+: A Validation Study of a Pediatric Acuity Risk Stratification Algorithm

Carl A Starvaggi; Sophie Affentranger; Noelie Lengeler; Johan N Siebert; Annick Galetto-Lacour; Rainer Tan; Manon Jaboyedoff; Claudia E Kuehni; Mary-Anne Hartley; Kristina Keitel

doi:10.1016/j.mcpdig.2025.100220

InfoKids+: A Validation Study of a Pediatric Acuity Risk Stratification Algorithm

Mayo Clin Proc Digit Health. 2025 Apr 15;3(2):100220. doi: 10.1016/j.mcpdig.2025.100220. eCollection 2025 Jun.

Authors

Carl A Starvaggi^{1

2

3}, Sophie Affentranger^{1

4}, Noelie Lengeler^{1

5}, Johan N Siebert⁶, Annick Galetto-Lacour⁶, Rainer Tan^{7

8}, Manon Jaboyedoff⁹, Claudia E Kuehni^{10

11}, Mary-Anne Hartley^{12

13}, Kristina Keitel^{1

8}

Affiliations

¹ Division of Pediatric Emergency Medicine, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland.
² Department of Orthopedic Surgery and Traumatology, Spitalzentrum Oberwallis, Brig, Switzerland.
³ Graduate School for Health Sciences, University of Bern, Bern, Switzerland.
⁴ Department of Pediatrics, Children's Hospital Lucerne, Lucerne Cantonal Hospital, Lucerne, Switzerland.
⁵ Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland.
⁶ Department of Pediatric Emergency Medicine, Geneva Children's Hospital, Geneva, University Hospitals, Geneva, Switzerland.
⁷ Unisanté, Center for Primary Care and Public Health, University of Lausanne, Lausanne, Switzerland.
⁸ Swiss Tropical and Public Health Institute, Allschwil, Switzerland.
⁹ Pediatric Infectious Diseases and Vaccinology Unit, Service of Pediatrics, Department Women-Mother-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
¹⁰ Division of Pediatric Respiratory Medicine and Allergology, Department of Pediatrics, Inselspital, Bern University Hospital, Bern, Switzerland.
¹¹ Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
¹² Laboratory for intelligent Global Health and Humanitarian Response Technologies (LiGHT), Yale School of Medicine, Department of Biomedical Informatics and Data Science, New Haven, CT.
¹³ Laboratory for intelligent Global Health and Humanitarian Response Technologies (LiGHT), EPFL, School of Computer Science, Lausanne, Switzerland.

Abstract

Objective: To prospectively validate InfoKids+, a pediatric acuity electronic risk stratification algorithm (eRSA), against a nurse-based triage standard (nbTS).

Participants and methods: We conducted a prospective validation study in a Swiss university hospital pediatric emergency department to assess the performance of a pediatric acuity eRSA, InfoKids+, on the basis of a well-established parental guidance application, InfoKids. Participants completed the eRSA once seated in a consultation booth. We compared the acuity levels from InfoKids+ (urgent, <4 hours; nonurgent, <24 hours; and no emergency, ≥24 hours) against an nbTS. The primary outcome was the level of agreement and rate of alignment between InfoKids+ and the reference standard.

Results: We included 1990 participants from June 3, 2020, through January 31, 2022. InfoKids+ showed a slight level of agreement with the nbTS (κ_lw=0.08; 95% CI, 0.06-0.10). InfoKids+ triaged 1762 (89%) cases as urgent (<4 hours), 106 (5%) as nonurgent (≤24 hours), and 122 (6%) as no emergency (≥24 hours), compared with 810 (41%), 843 (42%), and 337 (17%) triages by the nbTS, respectively (P<.001). InfoKids+ acuity level aligned with the reference standard in 888 (45%) cases, whereas it overreferred and underreferred in 999 (50%) and 103 (5%) cases, respectively (P<.001).

Conclusion: In summary, our study uncovered notable discrepancies between the InfoKids+ algorithmic triage and conventional nurse-based triage. Our results highlight the critical need for rigorous validation of such tools for accuracy and safety before public release to ensure these tools are beneficial and do not inadvertently cause harm or misallocation of resources.