Development of the Paediatric Appropriateness Evaluation Protocol for use in the United Kingdom.

Background: This paper describes a study to develop and test an instrument to measure the level of appropriate admissions and days of care in the paediatric hospital population.

Methods: The American version of the Paediatric Appropriateness Evaluation Protocol (PAEP) was modified by the consensus views of a panel of paediatricians and general practitioners. Reliability was tested in a pilot study in a random sample of 47 admissions from two district general hospitals.

Results: The agreement beyond chance for the raters using the PAEP for admission criteria was excellent (kappa = 0.848). It was poor (kappa = 0.345) for clinicians using subjective judgement. The agreement beyond chance for the day of care criteria was good (kappa =0.54). Trained reviewers achieved much higher reliability using the PAEP.

Conclusion: The modified PAEP achieved high reliability and was judged acceptable by clinicians to retrospectively assess the appropriateness of admissions in the UK setting.