A Validation Study of the Paediatric Non-Urgent Risk Assessment Management and Nurse Escort Assessment (PaNURAMA) Tool for Paediatric Inter-Hospital Transfers

M Davison; C Thomas; N White; L MacDowall; D Crookston; R Cole

doi:10.1111/1742-6723.70087

A Validation Study of the Paediatric Non-Urgent Risk Assessment Management and Nurse Escort Assessment (PaNURAMA) Tool for Paediatric Inter-Hospital Transfers

Emerg Med Australas. 2025 Aug;37(4):e70087. doi: 10.1111/1742-6723.70087.

Authors

M Davison^{1

2

3

4}, C Thomas^{1

2

4

5}, N White⁶, L MacDowall¹, D Crookston¹, R Cole^{1

2

7}

Affiliations

¹ Sunshine Coast University Hospital, Sunshine Coast Hospital and Health Service, Birtinya, Queensland, Australia.
² Maternal and Child Health, Sunshine Coast Health Institute, Birtinya, Queensland, Australia.
³ Emergency Service Line, Metro North Health, Caboolture, Queensland, Australia.
⁴ School of Medicine and Dentistry, Griffith University, Birtinya, Queensland, Australia.
⁵ Clinical Excellence Queensland, Queensland Health, Brisbane, Australia.
⁶ Australian Centre for Health Services Innovation, School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia.
⁷ School of Nursing, Midwifery and Social Work, University of Queensland, St Lucia, Australia.

Abstract

Objective: Decision support tools improve risk assessment in critical paediatric inter-hospital transfers (IHT), however, data on non-critical transfers of unwell children is limited. This study assessed the validity and reliability of a novel risk stratification tool, paediatric non-urgent risk assessment management and nurse escort assessment (PaNURAMA), designed to improve the quality of non-critical IHT for paediatric patients. Developed through expert multidisciplinary consultation, PaNURAMA provides three-tiered risk stratification to determine consultation, treatment, and escort needs: (i) Red (retrieval team co-ordination, medical escort considerations), (ii) Amber (specialist consultation, potential nurse escort) and (iii) Green (standard referral, no escort required).

Methods: PaNURAMA's accuracy in predicting risk stratification and nurse escort needs was evaluated utilising a randomised sample with de-identified data from 175 children that underwent IHTs (2019-2020). A blinded expert reviewer applied the tool to a pre-referral dataset, assigning predicted risk and escort requirements. Review and risk stratification of the post-arrival dataset was also completed. Sensitivity and specificity were assessed using an exact binomial test, targeting 80% sensitivity and 75% specificity.

Results: Of all cases, 68% were stratified as Amber, with 26% requiring an escort. Overall risk stratification agreement between pre- and post-transfer classifications was 94% (range 62% Red to 98% Amber). Intra-rater reliability was strong (κ = 0.83, 95% CI: 0.74-0.92). Escort allocation had 97% specificity for true negatives and 82% for true positives. Discrepancies reflected clinical improvements or additional findings post-referral.

Conclusion: PaNURAMA demonstrates strong validity and reliability in risk stratification and escort allocation supporting its use in transfer decision making for non-critical paediatric IHTs.

Keywords: child; decision making; interfacility transfer; inter‐hospital transfer; nurse escort; paediatric; patient transfer; risk stratification.

Publication types

Validation Study

MeSH terms

Adolescent
Child
Child, Preschool
Female
Humans
Infant
Male
Patient Transfer* / methods
Patient Transfer* / standards
Patient Transfer* / statistics & numerical data
Pediatrics* / methods
Pediatrics* / standards
Reproducibility of Results
Risk Assessment / methods
Risk Assessment / standards

Grants and funding

EMLE-163R34-2020-DAVISON/Emergency Medicine Foundation