Riyadh-Peds-ComPASS: Development and Validation of a Pediatric Complexity and Palliative Triage Tool

Children with chronic illnesses, including complex chronic conditions (CCCs) and life-limiting or life-threatening conditions (LLCs/LTCs), have multidimensional care needs that are not consistently identified in practice, leading to fragmented care and delayed supportive interventions. Existing assessment tools are often population-specific and focus on classification or referral identification. This study aimed to develop and psychometrically validate the Riyadh Pediatric Complexity and Palliative Needs Assessment Scale (Riyadh-Peds-ComPASS), a rapid, multidimensional triage tool designed to identify children and adolescents with medical complexity and palliative care needs, facilitate timely referral to specialized services, and support care planning. The tool development involved three phases: item development, theoretical analysis, and psychometric evaluation. Criterion validity, predictive validity, and inter-rater reliability were assessed. Large-scale validation included 150 children and adolescents (birth to 21 years) with diverse diagnoses and care needs at a tertiary care center in Saudi Arabia. The two-page Riyadh-Peds-ComPASS reliably assessed six domains of care complexity and generated a color-coded score (1-5) to guide interventions. The tool differentiated complexity levels and was usable by frontline healthcare providers with minimal training. Higher scores were significantly associated with DNAR status (adjusted OR = 4.32, 95% CI 2.27-8.20, P < .001), mortality within six months (adjusted OR = 6.06, 95% CI 2.30-16.00, P < .001), and palliative care involvement (χ 2 = 49.41, P < .001). The Riyadh-Peds-ComPASS appears to be a practical triage tool that may support early identification of medical complexity and palliative care needs, guide care planning, facilitate timely referrals, and improve care coordination across pediatric populations.