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Byrd C, Noelck M, Kerns E, Bryan M, Hamline M, Garber M, Ostrow O, Riss V, Shadman K, Shein S, Willer R, Ralston S. Multicenter Quality Collaborative to Reduce Overuse of High-Flow Nasal Cannula in Bronchiolitis. Pediatrics 2024; 153:e2023063509. [PMID: 38682254 DOI: 10.1542/peds.2023-063509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/03/2024] [Indexed: 05/01/2024] Open
Abstract
BACKGROUND AND OBJECTIVES High-flow nasal cannula (HFNC) for bronchiolitis increased over the past decade without clear benefit. This quality improvement collaborative aimed to reduce HFNC initiation and treatment duration by 30% from baseline. METHODS Participating hospitals either reduced HFNC initiation (Pause) or treatment duration (Holiday) in patients aged <24 months admitted for bronchiolitis. Participants received either Pause or Holiday toolkits, including: intervention protocol, training/educational materials, electronic medical record queries for data acquisition, small-group coaching, webinars, and real-time access to run charts. Pause arm primary outcome was proportion of patients initiated on HFNC. Holiday arm primary outcome was geometric mean HFNC treatment duration. Length of stay (LOS) was balancing measure for both. Each arm served as contemporaneous controls for the other. Outcomes analyzed using interrupted time series (ITS) and linear mixed-effects regression. RESULTS Seventy-one hospitals participated, 30 in the Pause (5746 patients) and 41 in the Holiday (7903 patients). Pause arm unadjusted HFNC initiation decreased 32% without LOS change. ITS showed immediate 16% decrease in initiation (95% confidence interval [CI] -27% to -5%). Compared with contemporaneous controls, Pause hospitals reduced HFNC initiation by 23% (95% CI -35% to -10%). Holiday arm unadjusted HFNC duration decreased 28% without LOS change. ITS showed immediate 11.8 hour decrease in duration (95% CI -18.3 hours to -5.2 hours). Compared with contemporaneous controls, Holiday hospitals reduced duration by 11 hours (95% CI -20.7 hours to -1.3 hours). CONCLUSIONS This quality improvement collaborative reduced HFNC initiation and duration without LOS increase. Contemporaneous control analysis supports intervention effects rather than secular trends toward less use.
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Affiliation(s)
- Courtney Byrd
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Michelle Noelck
- Division of Hospital Medicine, Department of Pediatrics, Oregon Health and Science University, Portland, Oregon
| | - Ellen Kerns
- Department of Pediatrics, University of Nebraska College of Medicine, Omaha, Nebraska
| | - Mersine Bryan
- Division of Hospital Medicine and General Pediatrics, University of Washington College of Medicine, Seattle, Washington
| | - Michelle Hamline
- Division of Clinical Pediatrics, University of California, Davis, Davis, California
| | - Matthew Garber
- Division of Hospital Pediatrics, Department of Pediatrics, University of Florida College of Medicine, Jacksonville, Florida
| | - Olivia Ostrow
- Division of Pediatric Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Valerie Riss
- Department of Pediatrics, University of Vermont College of Medicine, Burlington, Vermont
| | - Kristin Shadman
- Division of Hospital Medicine and Complex Care, Department of Pediatrics, University of Wisconsin College of Medicine, Madison, Wisconsin
| | - Steven Shein
- Departments of Pediatrics and Pediatric Critical Care, University Hospitals, Rainbow Babies and Children's, Cleveland, Ohio
| | - Robert Willer
- Department of Pediatric Hospital Medicine, University of Utah College of Medicine, Salt Lake City, Utah
| | - Shawn Ralston
- Division of Hospital Medicine and General Pediatrics, University of Washington College of Medicine, Seattle, Washington
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Smith JA, Stone BS, Shin J, Yen K, Reisch J, Fernandes N, Cooper MC. Association of outcomes in point-of-care lung ultrasound for bronchiolitis in the pediatric emergency department. Am J Emerg Med 2024; 75:22-28. [PMID: 37897916 DOI: 10.1016/j.ajem.2023.10.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 09/26/2023] [Accepted: 10/06/2023] [Indexed: 10/30/2023] Open
Abstract
BACKGROUND Acute bronchiolitis (AB) is the most common lower respiratory tract infection in infants. Objective scoring tools and plain film radiography have limited application, thus diagnosis is clinical. The role of point-of-care lung ultrasound (LUS) is not well established. OBJECTIVE We sought to characterize LUS findings in infants presenting to the pediatric ED diagnosed with AB, and to identify associations between LUS and respiratory support (RS) at 12 and 24 h, maximum RS during hospitalization, disposition, and hospital length of stay (LOS). METHODS Infants ≤12 months presenting to the ED and diagnosed with AB were enrolled. LUS was performed at the bedside by a physician. Lungs were divided into 12 segments and scanned, then scored and summated (min. 0, max. 36) in real time accordingly: 0 - A lines with <3 B lines per lung segment. 1 - ≥3 B lines per lung segment, but not consolidated. 2 - consolidated B lines, but no subpleural consolidation. 3 - subpleural consolidation with any findings scoring 1 or 2. Chart review was performed for all patients after discharge. RS was categorized accordingly: RS (room air), low RS (wall O2 or heated high flow nasal cannula <1 L/kg), and high RS (heated high flow nasal cannula ≥1 L/kg or positive pressure). RESULTS 82 subjects were enrolled. Regarding disposition, the mean (SD) LUS scores were: discharged 1.18 (1.33); admitted to the floor 4.34 (3.62); and admitted to the ICU was 10.84 (6.54). For RS, the mean (SD) LUS scores at 12 h were: no RS 1.56 (1.93), low RS 4.34 (3.51), and high RS 11.94 (6.17). At 24 h: no RS 2.11 (2.35), low RS 4.91 (3.86), and high RS 12.64 (6.48). Maximum RS: no RS 1.22 (1.31), low RS 4.11 (3.61), and high RS 10.45 (6.16). Mean differences for all dispositions and RS time points were statistically significant (p < 0.05, CI >95%). The mean (SD) hospital LOS was 84.5 h (SD 62.9). The Pearson correlation coefficient (r) comparing LOS and LUS was 0.489 (p < 0.0001). CONCLUSION Higher LUS scores for AB were associated with increased respiratory support, longer LOS, and more acute disposition. The use of bedside LUS in the ED may assist the clinician in the management and disposition of patient's diagnosed with AB.
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Affiliation(s)
- Jaron A Smith
- University of Texas Southwestern, Department of Pediatrics, Division of Emergency Medicine, Children's Medical Center, Dallas, TX, USA.
| | - Bethsabee S Stone
- University of Texas Southwestern, Department of Pediatrics, Division of Emergency Medicine, Children's Medical Center, Dallas, TX, USA.
| | - Jiwoong Shin
- University of Texas Southwestern, Department of Pediatrics, Division of Emergency Medicine, Children's Medical Center, Dallas, TX, USA.
| | - Kenneth Yen
- University of Texas Southwestern, Department of Pediatrics, Division of Emergency Medicine, Children's Medical Center, Dallas, TX, USA.
| | - Joan Reisch
- University of Texas Southwestern, School of Public Health, Division of Statistics, Dallas, TX, USA.
| | - Neil Fernandes
- University of Texas Southwestern, Department of Radiology, Division of Pediatric Radiology, Children's Medical Center, Dallas, TX, USA.
| | - Michael C Cooper
- University of Texas Southwestern, Department of Pediatrics, Division of Emergency Medicine, Children's Medical Center, Dallas, TX, USA.
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Martín-Latorre MDM, Martínez-Campos L, Martín-González M, Castro-Luna G, Lozano-Paniagua D, Nievas-Soriano BJ. Comparison of Easy-to-Use Bronchiolitis Scores in the Post-COVID-19 Era-An Observational Study. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1834. [PMID: 38136036 PMCID: PMC10742179 DOI: 10.3390/children10121834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 11/16/2023] [Accepted: 11/20/2023] [Indexed: 12/24/2023]
Abstract
In the post-restrictions COVID-19 period, the incidence of bronchiolitis in infants has increased considerably. Several scores determine the degree of severity of the bronchiolitis episode, but few are clinician-friendly. The main aim of this research was to find the easy-to-use score that most accurately estimated the severity of patients' infections according to their clinical situations and most accurately predicted the need for hospital admission. An observational cross-sectional study was performed in a reference pediatric hospital during the post-restrictions period of the COVID-19 pandemic (2021 and 2022). A comparison was made between the severity estimate provided by five international acute bronchiolitis scales and the clinical severity of the acute bronchiolitis episode. Three hundred and seventy-seven patients participated in the investigation, with a mean age of 5.68 months; 68.7% of the participants had a mild episode of bronchiolitis, 24.5% had a moderate episode, and 6.9% had a severe episode. The severity estimated by the Tal scale modified by McCallum showed a statistically significant correlation with the clinical severity established by clinical criteria (0.836; p < 0.001). It showed a high correlation with other international scores, such as the Wang score (0.820; p < 0.05) and the Wood-Downes-Ferrés score (0.936; p < 0.001). In the multivariate analysis, the constituent variables of the modified Tal score appeared in the final model that predicts the need for hospital admission. In the context of increased incidence after COVID-19, the Tal score modified by McCallum is an easy-to-use measuring instrument that presents an excellent concordance with the clinical severity estimated at first care contact. It also offers a more significant prediction of the need for hospital admission.
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Affiliation(s)
- María del Mar Martín-Latorre
- Department of Pediatrics, Torrecárdenas University Hospital, 04009 Almeria, Spain; (M.d.M.M.-L.); (L.M.-C.); (M.M.-G.); (G.C.-L.)
| | - Leticia Martínez-Campos
- Department of Pediatrics, Torrecárdenas University Hospital, 04009 Almeria, Spain; (M.d.M.M.-L.); (L.M.-C.); (M.M.-G.); (G.C.-L.)
| | - Manuel Martín-González
- Department of Pediatrics, Torrecárdenas University Hospital, 04009 Almeria, Spain; (M.d.M.M.-L.); (L.M.-C.); (M.M.-G.); (G.C.-L.)
- Nursing, Physiotherapy, and Medicine Department, University of Almeria, 04120 Almeria, Spain;
| | - Gracia Castro-Luna
- Department of Pediatrics, Torrecárdenas University Hospital, 04009 Almeria, Spain; (M.d.M.M.-L.); (L.M.-C.); (M.M.-G.); (G.C.-L.)
| | - David Lozano-Paniagua
- Nursing, Physiotherapy, and Medicine Department, University of Almeria, 04120 Almeria, Spain;
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Ralston SL. How Low Can You Go: What Is the Goal for Bronchiolitis Quality Improvement? Hosp Pediatr 2023; 13:e211-e212. [PMID: 37424407 DOI: 10.1542/hpeds.2023-007163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023]
Affiliation(s)
- Shawn L Ralston
- Department of Pediatrics, University of Washington, School of Medicine, Seattle, Washington; and Seattle Children's Hospital, Seattle Washington
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5
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Granda E, Urbano M, Andrés P, Corchete M, Cano A, Velasco R. Comparison of severity scales for acute bronchiolitis in real clinical practice. Eur J Pediatr 2023; 182:1619-1626. [PMID: 36702906 DOI: 10.1007/s00431-023-04840-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 01/09/2023] [Accepted: 01/21/2023] [Indexed: 01/28/2023]
Abstract
Several clinical scales have been developed to assess the severity of bronchiolitis as well as the probability of needing in-hospital care. A recent systematic review of 32 validated clinical scores for bronchiolitis concluded that 6 of them (Wood-Downes, M-WCAS, Respiratory Severity Score, Respiratory Clinical Score, Respiratory Score and Bronchiolitis risk of admission score) were the best ones regarding reliability, sensitivity, validity, and usability. However, to the best of our knowledge, no study has compared all of them in a clinical scenario. Also, after this review, three more scales were published: BROSJOD, Tal modified, and one score developed by PERN. Our main aim was to compare the ability of different clinical scales for bronchiolitis to predict any relevant outcome. A prospective observational study was conducted that included patients of up to 12 months old attended to, due to bronchiolitis, in the paediatric Emergency Department of a secondary university hospital from October 2019 to January 2022. For each patient, the attending clinician filled in a form with the items of the scales, decomposed, in order to prevent the clinician from knowing the score of each scale. Then, the patient was managed according to the protocol of our Emergency Department. A phone call was made to each patient in order to check whether the patient ended up being admitted in the next 48 h. In the case of those that were impossible to contact by phone, the clinical history was reviewed. For the purpose of the study, any of the following were considered to be a relevant outcome: admission to ward and need for supplementary oxygen, non-invasive ventilation (NIV) or intravenous fluids, and admission to the paediatric intensive care unit (PICU) within the next 48 h or death. For the aim of the study, the area under the curve (AUC) and the odds ratio (OR) for a relevant outcome were calculated in each scale. Also, the best cut-off point was estimated according to the Youden index, and its sensitivity (Sn) and specificity (Sp) for a relevant outcome were calculated. We included 265 patients (52.1% male) with a median age of 5.3 months (P25-P75 2.6-7.4). Among them, 46 (17.4%) had some kind of relevant outcome. AUC for prediction of a relevant outcome ranged from 0.705 (Respiratory Score) to 0.786 (BRAS), although no scale performed significantly better than others. A score ≤ 2 in the PERN scale showed a sensitivity of 91.3% (CI95% 79.7-96.6) for a relevant outcome, with only 4 misdiagnosed patients (only 2 of them needed NIV). Conclusions: There were no differences in the performance of the nine scales to predict relevant outcomes in patients with bronchiolitis. However, the PERN scale might be more useful to select patients at low risk of a severe outcome. What is Known: • Several clinical scales are used to assess the severity of bronchiolitis. Nevertheless, none of them seems to be better than others. What is New: • This is the first study comparing different bronchiolitis scales in a real clinical scenario. None of the nine scales compared performed better than the other. However, the PERN scale might be more useful to select patients at low risk of relevant outcomes.
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Affiliation(s)
- Elena Granda
- Pediatrics Department, Hospital Universitario Río Hortega, Valladolid, Spain.
| | - Mario Urbano
- Pediatrics Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Pilar Andrés
- Pediatrics Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Marina Corchete
- Pediatrics Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Alfredo Cano
- Pediatrics Department, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Roberto Velasco
- Pediatric Emergency Department, Hospital Universitario Río Hortega, Valladolid, Spain
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Buendia JA, Guerrero Patino D. Importance of respiratory syncytial virus as a predictor of hospital length of stay in bronchiolitis. F1000Res 2022; 10:110. [PMID: 35903216 PMCID: PMC9277196 DOI: 10.12688/f1000research.40670.4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/13/2022] [Indexed: 11/20/2022] Open
Abstract
Introduction : Bronchiolitis is the leading cause of hospitalization in children. Estimate potentially preventable variables that impact the length of hospital stay are a priority to reduce the costs associated with this disease. This study aims to identify clinical variables associated with length of hospital stay of bronchiolitis in children in a tropical middle-income country Methods: We conducted a retrospective cohort study in 417 infants with bronchiolitis in tertiary centers in Colombia. All medical records of all patients admitted through the emergency department were reviewed. To identify factors independently associated we use negative binomial regression model, to estimate incidence rate ratios (IRR) and adjust for potential confounding variables Results : The median of the length of hospital stay was 3.68 days, with a range of 0.74 days to 29 days, 138 (33.17%) of patients have a hospital stay of 5 or more days. After modeling and controlling for potential confounders age <6 months, comorbidities (CHD or neurological), BPD, chest indrawing, detection of RSV, and C-reactive protein were independent predictors of LOS Conclusions : Our results show that in infants with bronchiolitis, detection of RSV, age <6 months, comorbidities (CHD or neurological), BPD, chest indrawing, and C-reactive protein were independent predictors of LOS. As a potentially modifiable risk factor, efforts to reduce the probability of RSV infection can reduce the high medical cost associates with prolonged LOS in bronchiolitis.
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Affiliation(s)
- Jefferson Antonio Buendia
- Pharmacology and Toxicology Department, Pharmacology and Toxicology Research Group, Faculty of Medicine, Universidad de Antioquia., Medellín, Antioquia, 053212, Colombia
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7
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Schmit KM, Brown RL, Hayer S, Checovich M, Gern JE, Wald ER, Barrett B. Wisconsin Upper Respiratory Symptom Survey for Kids: Validation of an Illness-specific Quality of Life Instrument. Pediatr Res 2021; 90:1207-1214. [PMID: 33627821 PMCID: PMC8996437 DOI: 10.1038/s41390-021-01395-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 01/14/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute respiratory infections (ARIs) are the most common illness seen in the pediatric ambulatory setting. Research in this area is hampered by the lack of validated ARI measures. The aim of this study was to assess the reliability and validity of the Wisconsin Upper Respiratory Symptom Survey for Kids (WURSS-K), a 15-item instrument, which measures illness-specific symptoms and impact on quality of life during an ARI. METHODS WURSS-K was administered to two populations: (1) children aged 4-10 years recruited from the local community and (2) 9- and 10-year-old children from an ongoing study, the Urban Environment and Childhood Asthma. RESULTS Overall, 163 children with 249 ARI episodes completed WURSS-K. WURSS-K was analyzed using multiple models to evaluate reliability and validity for a two-factor structure (symptom and functionality) and a single global structure. These models provided evidence of reliability and validity with omega of 0.72 and 0.91 for symptoms and functionality along with the single structure with omega of 0.90. CONCLUSIONS WURSS-K shows strong psychometric properties for validity and reliability as either a single global factor or a two-factor structure. This instrument will be useful in both therapeutic trials and observational studies among children with ARI in ambulatory settings. IMPACT WURSS-K is a valid and reliable illness-specific quality of life instrument that evaluates the impacts of ARIs on children. WURSS-K is designed for children 4-10 years of age, for whom there is a lack of validated assessment tools. This now validated instrument will be useful for future observational studies and therapeutic trials among children with ARIs in ambulatory settings.
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Affiliation(s)
- Kathryn M. Schmit
- Department of Pediatrics, Division of Infectious Diseases, University of Wisconsin-Madison, Madison, WI,Corresponding author: Kathryn M. Schmit, MD, Department of Pediatrics, Division of Infectious Diseases, University of Wisconsin-Madison, 600 Highland Ave, Mail code 4108, Madison, WI, 53792, Phone 1(608)265-1425, Fax 1(608)265-2207,
| | - Roger L. Brown
- Research Design & Statistics Unit, University of Wisconsin-Madison School of Nursing, Madison, WI
| | | | | | - James E. Gern
- Department of Pediatrics, Division of Allergy and Immunology, University of Wisconsin-Madison, Madison, WI
| | - Ellen R. Wald
- Department of Pediatrics, Division of Infectious Diseases, University of Wisconsin-Madison, Madison, WI
| | - Bruce Barrett
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI
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8
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Vo AT, Liu DR, Schmidt AR, Festekjian A. Capillary blood gas in infants with bronchiolitis: Can end-tidal capnography replace it? Am J Emerg Med 2021; 45:144-148. [PMID: 33915447 DOI: 10.1016/j.ajem.2021.04.056] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/15/2021] [Accepted: 04/19/2021] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To explore the predictive ability of capillary blood gas (CBG) pCO2 for respiratory decompensation in infants aged ≤6 months with bronchiolitis admitted from the emergency department; to determine whether end-tidal CO2 (etCO2) capnography can serve as a less invasive substitute for CBG pCO2. STUDY DESIGN This was a prospective cohort study of previously healthy infants aged ≤6 months admitted for bronchiolitis from the emergency department (ED). Initial CBG pCO2 and etCO2 capnography were obtained in the ED prior to inpatient admission. Simple logistic regression modeling was used to examine the associations of CBG pCO2 and etCO2 capnography with respiratory decompensation. Pearson's correlation measured the relationship between CBG pCO2 and etCO2 capnography. RESULTS Of 134 patients, 61 had respiratory decompensation. There was a significant association between CBG pCO2 and respiratory decompensation (OR = 1.07, p = 0.003), even after outlying values were excluded (OR = 1.06, p = 0.005). End tidal CO2 capnography was not significantly associated with decompensation (OR = 1.02, p = 0.17), even after outlying values were excluded (OR = 1.02, p = 0.24). There was a moderate correlation between etCO2 capnography and CBG pCO2 (r = 0.39, p < 0.001). CONCLUSION In infants with bronchiolitis, CBG pCO2 provides an objective measure for predicting respiratory decompensation, and a single etCO2 measurement should not replace its use.
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Affiliation(s)
- Andrea T Vo
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd MS#113, LA, California 90027, USA.
| | - Deborah R Liu
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd MS#113, LA, California 90027, USA.
| | - Anita R Schmidt
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd MS#113, LA, California 90027, USA.
| | - Ara Festekjian
- Department of Pediatrics, Division of Emergency and Transport Medicine, Children's Hospital Los Angeles, 4650 Sunset Blvd MS#113, LA, California 90027, USA.
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Pinto FR, Alexandrino AS, Correia-Costa L, Azevedo I. Ambulatory chest physiotherapy in mild-to-moderate acute bronchiolitis in children under two years of age - A randomized control trial. Hong Kong Physiother J 2021; 41:99-108. [PMID: 34177198 PMCID: PMC8221980 DOI: 10.1142/s1013702521500098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/07/2021] [Indexed: 11/18/2022] Open
Abstract
Objective The aim of this study was to compare the role of a chest physiotherapy (CP) intervention to no intervention on the respiratory status of children under two years of age, with mild-to-moderate bronchiolitis. Methods Out of 80 eligible children observed in the Emergency Room, 45 children completed the study with 28 randomized to the intervention group and 17 to the control group. The intervention protocol, applied in an ambulatory setting, consisted of combined techniques of passive prolonged slow expiration, rhinopharyngeal clearance and provoked cough. The control group was assessed with no chest physiotherapy intervention. The efficacy of chest physiotherapy was assessed using the Kristjansson Respiratory Score at the admission and discharge of the visit to the Emergency Room and during clinical visits at day 7 and day 15. Results There was a significant improvement in the Kristjansson Respiratory Score in the intervention group compared to the control group at day 15 [1.2 (1.5) versus 0.3 (0.5); p -value = 0 . 005 , in the control and intervention groups, respectively], with a mean difference (95% CI) of - 0 . 9 ( - 1 . 6 to - 0 . 3 ). Conclusion Chest physiotherapy had a positive impact on the respiratory status of children with mild-to-moderate bronchiolitis. Clinical Trial Registration https://clinicaltrials.gov/ct2/show/NCT04260919.
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Affiliation(s)
- Frederico Ramos Pinto
- Department of Physical Medicine and Rehabilitation, Centro Hospitalar Universitário de São João, Alameda Professor Hernâni Monteiro, 4202-451 Porto, Portugal
| | - Ana Silva Alexandrino
- Department of Physiotherapy, School of Health Polytechnic of Porto, 4200-465 Porto, Portugal
| | - Liane Correia-Costa
- Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, 4050-313 Porto, Portugal.,EPIUnit, Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal.,Division of Pediatric Nephrology, Centro Materno-Infantil do Norte, Centro Hospitalar Universitário do Porto, 4050-371 Porto, Portugal
| | - Inês Azevedo
- EPIUnit, Instituto de Saúde Pública, Universidade do Porto, 4050-600 Porto, Portugal.,Department of Obstetrics-Gynecology and Pediatrics, Faculty of Medicine, Universidade do Porto, 4200-319 Porto, Portugal.,Department of Pediatrics, Centro Materno-Pediátrico, Centro Hospitalar Universitário de São João, 4200-319 Porto, Portugal
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10
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Shinta Devi NLP, Wanda D, Nurhaeni N. The Validity of the Modified Tal Score and Wang Respiratory Score Instruments in Assessing the Severity of Respiratory System Disorders in Children. Compr Child Adolesc Nurs 2019; 42:9-20. [PMID: 31192740 DOI: 10.1080/24694193.2019.1577921] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Nurses need to have a high awareness of children's respiratory status changes to prevent worse conditions such as respiratory failure. For this reason, nurses require a tool or instrument that can facilitate a comprehensive assessment of the severity of respiratory system disorders in children. The aim of this study was to identify the validity and reliability of the Modified Tal Score and Wang Respiratory Score instruments and their sensitivity and specificity for assessing the severity of respiratory system disorders in children. A descriptive-analytic research design and a cross-sectional approach were used in this research. A total of 48 children aged 0-2 years who were hospitalized in a top referral hospital in Jakarta with acute respiratory infections were assessed for the severity of respiratory system impairment using the Modified Tal Score and the Wang Respiratory Score instruments. The modified Tal Score had a strong correlation with SpO2 (r = -0.699; p = 0.0001; α = 0.05), as did the Wang Respiratory Score (r = -0.501; p = 0.0001; α = 0.05). The Cronbach's Alpha value for the Modified Tal Score instrument was 0.768, while that for the Wang Respiratory Score instrument was 0.68. Analysis using ROC curves gave an AUC value of 0.897 (95% CI 0.794; 1, p = 0.0001) for the Modified Tal Score instrument for predicting the severity of respiratory system disorders in children versus 0.815 (95% CI 0.681; 0.95, p = 0.0001) for the Wang Respiratory Score instrument. These results showed that the Modified Tal Score instrument has higher validity and reliability, as well as better sensitivity and specificity, than the Wang Respiratory Score instrument for assessing the severity of respiratory system disorders in children. A further study for instruments' improvement by classifying the children's respiratory rate according to their age, as well as adding an item related to the use of supplementary oxygen, is needed.
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Affiliation(s)
- Ni Luh Putu Shinta Devi
- a Department of Pediatric Nursing, Faculty of Nursing Universitas Indonesia , Depok , Indonesia.,b Nursing Study Program, Faculty of Medicine , Udayana University , Bali , Indonesia
| | - Dessie Wanda
- a Department of Pediatric Nursing, Faculty of Nursing Universitas Indonesia , Depok , Indonesia
| | - Nani Nurhaeni
- a Department of Pediatric Nursing, Faculty of Nursing Universitas Indonesia , Depok , Indonesia
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Urpí-Fernández AM, Zabaleta-Del-Olmo E, Montes-Hidalgo J, Tomás-Sábado J, Roldán-Merino JF, Lluch-Canut MT. Instruments to assess self-care among healthy children: A systematic review of measurement properties. J Adv Nurs 2017; 73:2832-2844. [PMID: 28617980 DOI: 10.1111/jan.13360] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2017] [Indexed: 11/28/2022]
Abstract
AIM To identify, critically appraise and summarize the measurement properties of instruments to assess self-care in healthy children. BACKGROUND Assessing self-care is a proper consideration for nursing practice and nursing research. No systematic review summarizes instruments of measurement validated in healthy children. DESIGN Psychometric review in accordance with the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) panel. DATA SOURCES MEDLINE, CINAHL, PsycINFO, Web of Science and Open Grey were searched from their inception to December 2016. REVIEW METHODS Validation studies with a healthy child population were included. Search was not restricted by language. Two reviewers independently assessed the methodological quality of included studies using the COSMIN checklist. RESULTS Eleven studies were included in the review assessing the measurement properties of ten instruments. There was a maximum of two studies per instrument. None of the studies evaluated the properties of test-retest reliability, measurement error, criterion validity and responsiveness. Internal consistency and structural validity were rated as "excellent" or "good" in four studies. Four studies were rated as "excellent" in content validity. Cross-cultural validity was rated as "poor" in the two studies (three instruments) which cultural adaptation was carried out. CONCLUSION The evidence available does not allow firm conclusions about the instruments identified in terms of reliability and validity. Future research should focus on generate evidence about a wider range of measurement properties of these instruments using a rigorous methodology, as well as instrument testing on different countries and child population.
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Affiliation(s)
- Ana-María Urpí-Fernández
- Primary Care Nurse, "Carles I" Primary Health Care Centre, Institut Català de la Salut, Barcelona, Spain
| | - Edurne Zabaleta-Del-Olmo
- Institut Universitari d'Investigació en Atenció Primària (IDIAP) Jordi Gol, Barcelona, Spain.,Universitat Autònoma de Barcelona, Bellaterra (Cerdanyola del Vallès), Spain.,Faculty of Nursing, Universitat de Girona, Girona, Spain
| | - Javier Montes-Hidalgo
- School of Nursing, Gimbernat i Tomàs Cerdà, Universitat Autònoma de Barcelona, Sant Cugat del Vallès, Spain
| | - Joaquín Tomás-Sábado
- School of Nursing, Gimbernat i Tomàs Cerdà, Universitat Autònoma de Barcelona, Sant Cugat del Vallès, Spain
| | - Juan-Francisco Roldán-Merino
- Department of Public Health, Mental Health and Maternal-Child Nursing, Sant Joan de Deu School of Nursing, University of Barcelona, Barcelona, Spain
| | - María-Teresa Lluch-Canut
- School of Nursing, Department of Public Health, Mental Health and Maternal-Child Nursing, University of Barcelona, L'Hospitalet de Llobregat, Barcelona, Spain
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