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.