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Abstract Objective To evaluate the validity of the triage system CLARIPED in a pediatric population in the city of São Paulo, Brazil. Methods Prospective, observational study in a secondary-level pediatric emergency service from Sep-2018 to Ago-2019. A convenience sample of all patients aged 0-18 years triaged by the computerized CLARIPED system was selected. Associations between urgency levels and patient outcomes were analyzed to assess construct validity. Sensitivity, specificity, and positive and negative predictive values (PPV and NPV) to identify the most urgent patients were estimated, as well as under-triage and over-triage rates. Results The distribution of 24,338 visits was: RED 0.02%, ORANGE 0.9%, YELLOW 23.5%, GREEN 47.9%, and BLUE 27.7% (highest to the lowest level of urgency). The frequency of the following outcomes increased with increasing urgency: hospital admission (0.0%, 0.02%, 0.1%, 7.1% and 20%); stay in ED observation room (1.9%, 2,4%, 4.8%, 24.1%, 60%); use of ≥ 2 diagnostic/therapeutic resources (2.3%, 3.0%, 5.9%, 28.8%, 40%); ED length of stay (12, 12, 15, 99.5, 362 min). The most urgent patients (RED, ORANGE, and YELLOW) exhibited higher chances of using ≥ 2 resources (OR 2.55; 95%CI: 2.23-2.92) or of being hospitalized (OR 23.9; 95%CI: 7.17-79.62), compared to the least urgent (GREEN and BLUE). The sensitivity to identify urgency was 0.88 (95%CI: 0.70-0.98); specificity, 0.76 (95%CI: 0.75-0.76); NPV, 0.99 (95%CI: 0.99-1.00); overtriage rate, 23.0%, and undertriage, 11.5%. Conclusion This study corroborates the validity and safety of CLARIPED, demonstrating significant correlations with clinical outcomes, good sensitivity, and low undertriage rate in a secondary-level Brazilian pediatric emergency service. Paulo Brazil Prospective secondarylevel secondary Sep2018 Sep 2018 Sep-201 Ago2019. Ago2019 Ago 2019. 2019 Ago-2019 018 0 18 0-1 selected Sensitivity specificity PPV NPV estimated under over rates 24338 24 338 24,33 002 02 0.02% 09 9 0.9% 235 23 5 23.5% 479 47 47.9% 277 27 7 27.7 highest urgency. . urgency) 0.0%, 00 (0.0% 01 1 0.1% 71 7.1 20% 20 20%) 1.9%, 19 (1.9% 4 2,4% 48 8 4.8% 241 24.1% 60% 60 60%) diagnostictherapeutic diagnostic therapeutic 2.3%, 3 (2.3% 30 3.0% 59 5.9% 288 28 28.8% 40% 40 40%) 12 (12 15 995 99 99.5 36 min. min min) RED, (RED OR 2.55 255 55 95%CI 95CI CI 95 2.232.92 223292 2.23 2.92 92 2.23-2.92 23.9 239 7.1779.62, 7177962 7.17 79.62 , 17 79 62 7.17-79.62) BLUE. BLUE) 088 88 0.8 (95%CI 0.700.98 070098 0.70 0.98 70 98 0.70-0.98) 076 76 0.7 0.750.76 075076 0.75 75 0.75-0.76) 099 0.9 0.991.00 099100 1.00 0.99-1.00) 230 23.0% 115 11 11.5% Sep201 201 Sep-20 Ago201 Ago-201 0- 2433 33 24,3 0.02 23.5 47.9 27. 0.0% (0.0 0.1 7. 1.9% (1.9 2,4 4.8 24.1 6 2.3% (2.3 3.0 5.9 28.8 (1 99. 2.5 25 232 2.232.9 22329 223 2.2 292 2.9 2.23-2.9 23. 1779 7.1779.62 717796 717 7962 79.6 7.17-79.62 08 0. 700 0.700.9 07009 070 098 0.70-0.98 07 750 0.750.7 07507 075 0.75-0.76 991 0.991.0 09910 100 1.0 0.99-1.00 23.0 11.5 Sep20 Sep-2 Ago20 Ago-20 243 24, 0.0 47. (0. 1.9 (1. 2, 4. 24. 2.3 (2. 3. 5. 28. ( 2. 2.232. 2232 22 29 2.23-2. 177 7.1779.6 71779 796 79. 7.17-79.6 0.700. 0700 0.70-0.9 0.750. 0750 0.75-0.7 0.991. 0991 10 1. 0.99-1.0 11. Sep2 Sep- Ago2 Ago-2 (0 (2 2.232 2.23-2 7.1779. 7177 7.17-79. 0.700 0.70-0. 0.750 0.75-0. 0.991 0.99-1. Ago- 2.23- 7.1779 7.17-79 0.70-0 0.75-0 0.99-1 7.177 7.17-7 0.70- 0.75- 0.99- 7.17-