Indian Pediatr 2019;56: 333-334
An Indian Tool for Assessing Appropriateness of Pediatric
Shahid Akhtar Siddiqui
Department of Pediatrics, SN Children Hospital, MLN
Medical College, Allahabad, Uttar Pradesh, India.
Das, et al.  published their unique study on a tool for
assessing appropriateness of pediatric hospitalization in a recent issue
of Indian Pediatrics. I seek following clarifications:
• Authors used semi-Delphi technique to arrive at
pre-defined objectives. What were the intended objectives/end points
of Delphi method?
• What was the method of raters’ orientation?
• Authors assessed appropriateness of
hospitalization of 274 patients during a period from July-September
2015 from five medical colleges in Delhi and surrounding states.
This comes out as 0.6 case/day/medical college. Considering that all
these are public hospitals, number of hospitalizations would have
been much higher. What was the sampling method to select only 274
• Sampling should also have taken account of
season when minimum/least number of admission season for better
validity and more accurate representative of actual population.
There are more chances of appropriateness of admission criteria in
peak season than in trough season of admissions. Bianco, et al.
 reported that inappropriate admission was significantly higher
if it occurred during the daytime. Considering the circumstances in
such hospitals (less chances of follow-up, biased health seeking
behavior for male children, distance from home to hospital,
availability of night conveyance, ignorance, loss of wages for
attending health facility), admission at night time tend to be more
inappropriate as compared to day time. Were these factors taken into
• Sample consisted of 274 patients from Northern
India (Delhi-NCR) and 622 from Southern India (Coimbatore and Kollam).
The population from Sothern India consisted of mostly infants which
were part of another study, and taken from 146 hospitals. So
overall, almost two-thirds of sample population were infants making
the tool less valid for older age groups. Besides that, not all
states of India have same Doctor and bed availability . Thus,
samples should have been more representative of the country to have
more valid applicability of results.
1. Das MK, Arora NK, Poloru R, Seth A, Aggarwal A,
Dubey AP, et al. Pediatric Appropriate Evaluation Protocol for
India (PAEP-India): Tool for assessing appropriateness of pediatric
hospitalization. Indian Pediatr. 2018;55:1041-5.
2. Bianco A, Pileggi C, Trani F, Angelillo IF.
Appropriateness of admissions and days of stay in pediatric wards of
Italy. Pediatrics. 2003;112:124-8.
3. Press Information Bureau, Government of India.
Hospital Beds in India. Available from: http://pib.nic.in/newsite/PrintRelease.aspx?relid=98206.
Assessed December 13, 2018.