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a London Health Economics
Consortium, London School of Hygiene and Tropical Medicine, b Wessex Primary Care Research Network, Southampton, c Nuffield Institute for Health, Leeds, d Royal College of Paediatrics and Child
Health, London
Correspondence to: Dr R MacFaul, Health Services Committee, Royal College of Paediatrics and Child Health, 5 St Andrews Place, Regents Park, London NW1 4 LB.
Accepted 21
May 1997
The reliability and validity of the North American paediatric
appropriateness evaluation protocol (PAEP) for use in paediatric practice in Britain was tested. The protocol was applied to 418 case
records of consecutive emergency admissions to three Yorkshire district
general hospitals. The PAEP ratings were then compared with a clinical
consensus opinion obtained from two expert panels. Altogether 32% of
the admissions were rated inappropriate by the PAEP and 36% by the
panels. Validity of the PAEP, as measured by agreement beyond chance
with the expert panel rating, was only moderate with a 
of 0.29 (95% confidence interval 0.11 to 0.47). The PAEP has limited validity
for evaluating British paediatric practice. Utilisation review
instruments developed in differing clinical cultures should be used
with caution until shown to be valid for the practice setting under review.
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