Acurácia de dois escores pediátricos de alerta precoce de deterioração clínica no contexto brasileiro
Resumen
Objetivo: comparar a acurácia e a reprodutibilidade do Escore Pediátrico de Alerta (EPA) e da versão brasileira do Brighton Paediatric Early Warning Score (BPEWS-Br) na identificação de sinais de deterioração clínica no contexto brasileiro. Método: estudo de acurácia de teste diagnóstico, realizado em um hospital materno-infantil de grande porte, com 240 crianças e adolescentes de 0 a 15 anos, de outubro de 2018 a maio de 2019. Os instrumentos para coleta foram o BPEWS, o EPA e os critérios da avaliação clínica primária da criança gravemente doente, recomendados pela American Heart Association como padrão de referência. Os dados foram analisados no MedCalc® Statistical Software, version 20.007, para estimar indicadores de acurácia e concordância entre os escores. Resultados: o EPA variou de 0 a 7 e o BPEWS-Br de 0 a 8. Considerando um escore ≥ 3, o EPA obteve prevalência de deterioração de 19,5%, o BPEWS-Br de 16,7% e o padrão de referência de 22,1%. As áreas sob as Curvas ROC do BPEWS-Br e do EPA se mostraram praticamente iguais, de 93,5% (IC: 90 – 97) e 93,6% (IC: 89,8 – 97,4), respectivamente, o que evidencia alta acurácia dos testes. O Índice Kappa entre os escores foi de 0,879 (IC 95%: 0,845 a 0,912), mostrando alta concordância. Conclusão: os indicadores de acurácia e reprodutibilidade do BPEWS-Br e do EPA foram elevados.
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