1
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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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2
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Craig S, Xu Y, Robas K, Iramain R, Yock-Corrales A, Soto-Martinez ME, Rino P, Belen Alvarez Ricciardi M, Piantanida S, Mahant S, Ubuane PO, Odusote O, Kwok M, Johnson MD, Paniagua N, Benito Fernandez J, Ong GY, Lyttle MD, Gong J, Roland D, Dalziel SR, Nixon GM, Powell CVE, Graudins A, Babl FE. Core outcomes and factors influencing the experience of care for children with severe acute exacerbations of asthma: a qualitative study. BMJ Open Respir Res 2023; 10:e001723. [PMID: 37968074 PMCID: PMC10661079 DOI: 10.1136/bmjresp-2023-001723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Accepted: 10/27/2023] [Indexed: 11/17/2023] Open
Abstract
OBJECTIVE To identify the outcomes considered important, and factors influencing the patient experience, for parents and caregivers of children presenting to hospital with a severe acute exacerbation of asthma. This work contributes to the outcome-identification process in developing a core outcome set (COS) for future clinical trials in children with severe acute asthma. DESIGN A qualitative study involving semistructured interviews with parents and caregivers of children who presented to hospital with a severe acute exacerbation of asthma. SETTING Hospitals in 12 countries associated with the global Pediatric Emergency Research Networks, including high-income and middle-income countries. Interviews were conducted face-to-face, by teleconference/video-call, or by phone. FINDINGS Overall, there were 54 interviews with parents and caregivers; 2 interviews also involved the child. Hospital length of stay, intensive care unit or high-dependency unit (HDU) admission, and treatment costs were highlighted as important outcomes influencing the patient and family experience. Other potential clinical trial outcomes included work of breathing, speed of recovery and side effects. In addition, the patient and family experience was impacted by decision-making leading up to seeking hospital care, transit to hospital, waiting times and the use of intravenous treatment. Satisfaction of care was related to communication with clinicians and frequent reassessment. CONCLUSIONS This study provides insight into the outcomes that parents and caregivers believe to be the most important to be considered in the process of developing a COS for the treatment of acute severe exacerbations of asthma.
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Affiliation(s)
- Simon Craig
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Paediatric Emergency Department, Monash Medical Centre Clayton, Clayton, Victoria, Australia
- Emergency Research, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
| | - Yao Xu
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Kael Robas
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
| | - Ricardo Iramain
- Paediatric Emergency Department, Hospital de Clinicas, Asuncion, Paraguay
| | - Adriana Yock-Corrales
- Emergency Department, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera". Caja Costarricense Seguro Social, San José, Costa Rica
| | - Manuel E Soto-Martinez
- Department of Pediatrics, School of Medicine, Universidad de Costa Rica, San José, Costa Rica
- Respiratory Medicine Division, Department of Pediatrics, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera". Caja Costarricense Seguro Social, San José, Costa Rica
| | - Pedro Rino
- Pediatric Emergency Department, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
- Universidad de Buenos Aires, Buenos Aires, Argentina
| | | | - Sofia Piantanida
- Pediatric Emergency Department, Hospital de Pediatria Prof Dr Juan P Garrahan, Buenos Aires, Argentina
| | - Sanjay Mahant
- Child Health Evaluative Services, Research Institute, The Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Peter Odion Ubuane
- Institute of Maternal and Child Health/Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Olatunde Odusote
- Institute of Maternal and Child Health/Department of Paediatrics, Lagos State University Teaching Hospital, Ikeja, Lagos, Nigeria
| | - Maria Kwok
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, USA
- Division of Emergency Medicine, New York Presbyterian Hospital-Morgan Stanley Children's Hospital, New York, New York, USA
| | - Michael D Johnson
- Division of Paediatric Emergency Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, Utah, USA
- Emergency Department, Primary Children's Hospital, Salt Lake City, Utah, USA
| | - Natalia Paniagua
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo, País Vasco, Spain
- Paediatric Emergency Department. Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Javier Benito Fernandez
- Pediatric Emergency Department, Cruces University Hospital, Barakaldo, País Vasco, Spain
- Paediatric Emergency Department. Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Gene Y Ong
- Children's Emergency Department, KK Women's and Children's Hospital, Singapore
| | - Mark D Lyttle
- Research in Emergency Care Avon Collaborative Hub (REACH), University of the West of England, Bristol, UK
- Emergency Department, Bristol Royal Hospital for Children, Bristol, UK
| | - Jin Gong
- Department of Paediatrics, Affiliated Renhe Hospital of China, Yichang, Hubei, China
- Department of Paediatrics, China Three Gorges University, Yichang, Hubei, China
| | - Damian Roland
- SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
- Paediatric Emergency Medicine Leicester Academic Group, Children's Emergency Department, Leicester Royal Infirmary, Leicester, UK
| | - Stuart R Dalziel
- Children's Emergency Department, Starship Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health, The University of Auckland, Auckland, New Zealand
| | - Gillian M Nixon
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Department of Respiratory Medicine, Monash Children's Hospital, Clayton, Victoria, Australia
| | - Colin V E Powell
- Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, UK
- Sidra Medicine Department of Emergency Medicine, Doha, Ad-Dawhah, Qatar
| | - Andis Graudins
- Emergency Department, Monash Health, Dandenong Hospital, Dandenong, Victoria, Australia
- Department of Medicine, Monash University, Clayton, Victoria, Australia
| | - Franz E Babl
- Department of Paediatrics, School of Clinical Sciences, Monash University, Clayton, Victoria, Australia
- Emergency Research, Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, Australia
- Department of Emergency Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia
- Departments of Paediatrics and Critical Care, University of Melbourne, Parkville, Victoria, Australia
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3
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Kulkarni S, Kurane A, Sakate D. Impulse Oscillometry System for the Diagnosis of Wheezing Episode in Children in Office Practice. J Asthma Allergy 2022; 15:353-362. [PMID: 35320988 PMCID: PMC8935627 DOI: 10.2147/jaa.s344643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background and Objective Objectively differentiating between wheezing episodes and other respiratory disorders will be helpful in treatment in office practice. The impulse oscillometry system has been useful in assessing airway resistance in children 3–6 years old. As the reference values are different in geographical regions the use of the impulse oscillometry is still limited. Comparison between the percent change in IOS parameters as compared to reference standards and changes in actual IOS parameters was done to diagnose wheezing episodes. Methodology Three to six years old children with a history of fever, cough, cold, and/or breathlessness with noisy breathing and who were not on any regular medications, whose parents gave consent were recruited in the study. The children underwent an impulse oscillometry system examination as per the guidelines. The test was repeated after they were given nebulization by salbutamol (2.5 mg) (before COVID 19 pandemic). Final diagnosis was done by following patients for 7 days. Results About 106 children were recruited in the study. Five children could not perform the IOS test. Eighteen children did not complete the follow-up. Hence, 83 children were analyzed. There were 47 males and 36 female patients. The change in actual values of AX, R5, and X20 showed statistically significant difference in wheezing episode group (p-value<0.001). The percentage change as compared to predicted values of R5 and X20 also showed a statistically significant difference in the wheezing episode group and the others group (p-value<0.001). Conclusion The change in actual values of AX, R5, X20, and resonant frequency may help to differentiate wheezing episode from other respiratory diseases.
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Affiliation(s)
- Suhas Kulkarni
- Department of Pediatrics, D.Y. Patil Medical College, Kolhapur, Maharashtra, India
- Correspondence: Suhas Kulkarni, D.Y. Patil Medical College, Kolhapur, Maharashtra, India, Tel +91 231 2601235, Fax +91 231260138, Email
| | - Anil Kurane
- Department of Pediatrics, D.Y. Patil Medical College, Kolhapur, Maharashtra, India
| | - Deepak Sakate
- Department of Statistics and Applied Mathematics, Central University of Tamil Nadu, Thiruvarur, Tamil Nadu, India
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4
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Siraj S, Stark W, McKinley SD, Morrison JM, Sochet AA. The bronchiolitis severity score: An assessment of face validity, construct validity, and interobserver reliability. Pediatr Pulmonol 2021; 56:1739-1744. [PMID: 33629813 DOI: 10.1002/ppul.25337] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Revised: 02/02/2021] [Accepted: 02/20/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To assess face validity, interobserver reliability, and the ability to discriminate escalations of care within 24-h of admission (late rescues) for the bronchiolitis severity score (BSS) for children hospitalized for acute bronchiolitis. HYPOTHESES The BSS will yield variable face validity, have clinically relevant interobserver reliability (kappa > 0.7), and distinguish late rescues during hospitalization. METHODS We performed a combined retrospective and prospective, mixed methods study where (1) interobserver agreement was prospectively assessed by overall and subcategory congruence (kappa) calculations, (2) face value were qualitatively assessed from aggregate questionnaire responses, and (3) construct validity for late rescues were assessed using receiver operator characteristic (ROC) curve analyses. RESULTS Face validity, assessed from 39 questionnaire respondents, were generally positive for BSS utility, reliability, and usability. The BSS exhibited weak interobserver reliability (kappa = 0.22, 95% confidence interval [CI]: 0.11-0.31) calculated from 72 sequential, blinded calculations. Retrospectively, 181 children less than 2 years of age admitted to the general pediatric ward for acute bronchiolitis from November 2017 to April 2019 were identified of which 18 (9.9%) experienced late rescues. Admission BSS values were no different for children with and without late rescues (6[3,6] vs. 4[3,6]; p = .09). An ROC curve analysis revealed an area under the curve of 0.61 (95% CI: 0.48-0.75; threshold ≥6 with sensitivity = 56%, specificity = 69%) for BSS to discriminate late rescues. CONCLUSION Although clinicians expressed favorable perceptions of BSS face and content validity, we noted weak interobserver reliability and limited construct validity. Further development and validation are needed to strengthen the BSS before routine use.
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Affiliation(s)
- Shaila Siraj
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida, USA.,Division of Hospital Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Wayne Stark
- Divisions of Emergency Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Scott Daniel McKinley
- Division of Pulmonlogy, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - John Michael Morrison
- Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Division of Hospital Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
| | - Anthony Alexander Sochet
- Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida, USA.,Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.,Division of Pediatric Critical Care Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida, USA
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5
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Lee MO, Sivasankar S, Pokrajac N, Smith C, Lumba‐Brown A. Emergency department treatment of asthma in children: A review. J Am Coll Emerg Physicians Open 2020; 1:1552-1561. [PMID: 33392563 PMCID: PMC7771822 DOI: 10.1002/emp2.12224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/27/2020] [Accepted: 07/28/2020] [Indexed: 12/11/2022] Open
Abstract
Asthma is the most common chronic illness in children, with >700,000 emergency department (ED) visits each year. Asthma is a respiratory disease characterized by a combination of airway inflammation, bronchoconstriction, bronchial hyperresponsiveness, and variable outflow obstruction, with clinical presentations ranging from mild to life-threatening. Standardized ED treatment can improve patient outcomes, including fewer hospital admissions. Informed by the most recent guidelines, this review focuses on the optimal approach to diagnosis and treatment of children with acute asthma exacerbations who present to the ED.
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Affiliation(s)
- Moon O. Lee
- Department of Emergency MedicineStanford University School of MedicineStanfordCaliforniaUSA
| | - Shyam Sivasankar
- Department of Emergency MedicineStanford University School of MedicineStanfordCaliforniaUSA
| | - Nicholas Pokrajac
- Department of Emergency MedicineStanford University School of MedicineStanfordCaliforniaUSA
| | - Cherrelle Smith
- Department of Emergency MedicineStanford University School of MedicineStanfordCaliforniaUSA
| | - Angela Lumba‐Brown
- Department of Emergency MedicineStanford University School of MedicineStanfordCaliforniaUSA
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6
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Finette BA, McLaughlin M, Scarpino SV, Canning J, Grunauer M, Teran E, Bahamonde M, Quizhpe E, Shah R, Swedberg E, Rahman KA, Khondker H, Chakma I, Muhoza D, Seck A, Kabore A, Nibitanga S, Heath B. Development and Initial Validation of a Frontline Health Worker mHealth Assessment Platform (MEDSINC ®) for Children 2-60 Months of Age. Am J Trop Med Hyg 2020; 100:1556-1565. [PMID: 30994099 PMCID: PMC6553915 DOI: 10.4269/ajtmh.18-0869] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Approximately 3 million children younger than 5 years living in low- and middle-income countries (LMICs) die each year from treatable clinical conditions such as pneumonia, dehydration secondary to diarrhea, and malaria. A majority of these deaths could be prevented with early clinical assessments and appropriate therapeutic intervention. In this study, we describe the development and initial validation testing of a mobile health (mHealth) platform, MEDSINC®, designed for frontline health workers (FLWs) to perform clinical risk assessments of children aged 2–60 months. MEDSINC is a web browser–based clinical severity assessment, triage, treatment, and follow-up recommendation platform developed with physician-based Bayesian pattern recognition logic. Initial validation, usability, and acceptability testing were performed on 861 children aged between 2 and 60 months by 49 FLWs in Burkina Faso, Ecuador, and Bangladesh. MEDSINC-based clinical assessments by FLWs were independently and blindly correlated with clinical assessments by 22 local health-care professionals (LHPs). Results demonstrate that clinical assessments by FLWs using MEDSINC had a specificity correlation between 84% and 99% to LHPs, except for two outlier assessments (63% and 75%) at one study site, in which local survey prevalence data indicated that MEDSINC outperformed LHPs. In addition, MEDSINC triage recommendation distributions were highly correlated with those of LHPs, whereas usability and feasibility responses from LHP/FLW were collectively positive for ease of use, learning, and job performance. These results indicate that the MEDSINC platform could significantly increase pediatric health-care capacity in LMICs by improving FLWs’ ability to accurately assess health status and triage of children, facilitating early life-saving therapeutic interventions.
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Affiliation(s)
- Barry A Finette
- THINKMD, Inc., Burlington, Vermont.,University of Vermont Robert Larner College of Medicine, Vermont Children's Hospital, Burlington, Vermont
| | | | | | | | | | | | | | - Edy Quizhpe
- University of San Francisco de Quito- Ecuador Ministry of Health-Affiliate, Quito, Ecuador
| | - Rashed Shah
- Save the Children - US, Fairfield, Connecticut
| | | | | | | | - Ituki Chakma
- Save the Children - International Bangladesh, Dhaka, Bangladesh
| | | | - Awa Seck
- UNICEF-Burkina Faso, Ouagadougou, Burkina Faso
| | | | | | - Barry Heath
- THINKMD, Inc., Burlington, Vermont.,University of Vermont Robert Larner College of Medicine, Vermont Children's Hospital, Burlington, Vermont
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7
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Ryan KS, Son S, Roddy M, Siraj S, McKinley SD, Nakagawa TA, Sochet AA. Pediatric asthma severity scores distinguish suitable inpatient level of care for children admitted for status asthmaticus. J Asthma 2019; 58:151-159. [PMID: 31608716 DOI: 10.1080/02770903.2019.1680998] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Objective: To determine if the Pediatric Asthma Severity Score (PASS) can distinguish "late-rescues" (transfer to the pediatric intensive care unit [PICU] within 24-hours of general pediatric floor admission), "PICU readmissions" (readmission within 24-h after transfer to a lower inpatient level of care), and unplanned 30-day hospital readmission in children admitted with status asthmaticus.Methods: We performed a single center, retrospective cohort study in 328 children admitted for asthma exacerbation aged 5-18 years from May 2015 to October 2017. We sought to determine if PASS values preceding admission from the emergency department or transfer to the general pediatric unit will be greater in children with late rescues and PICU readmissions and if a cutoff PASS values exist to discriminate these events prior to intrafacility transfer.Results: Nine (5%) late-rescues and 5 (3%) PICU readmissions accounted for 14/328 (4%) composite outcomes. PASS values were greater in children with these events (8 [IQR:5-8] vs. 5 [IQR:3-6], p < .01). Logistic regression of PASS on composite outcome yielded an odds ratio of 1.4 (1.1-1.8, p < .01) and ROC curve of PASS on a composite outcome yielded an AUC of 0.74 (0.61-0.87) with a threshold of ≥ 9. Nine (3%) children experienced unplanned 30-day hospital readmissions but PASS preceding hospital discharge was neither discriminative nor associated with hospital readmission.Conclusions: PASS values ≥ 9 identify children at increased risk for late-rescue and PICU readmission. Applied with traditionally criteria for selection of inpatient level of care, PASS may assist providers in reducing acute inpatient disposition errors.
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Affiliation(s)
- Kelsey S Ryan
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,Department of Pediatrics, University of South Florida, Tampa, FL, USA
| | - Sorany Son
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Meghan Roddy
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Shaila Siraj
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,Department of Pediatrics, University of South Florida, Tampa, FL, USA.,School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | | | - Thomas A Nakagawa
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,School of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - Anthony A Sochet
- Johns Hopkins All Children's Hospital, St. Petersburg, FL, USA.,Department of Pediatrics, University of South Florida, Tampa, FL, USA.,School of Medicine, Johns Hopkins University, Baltimore, MD, USA
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8
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de Groot MG, de Neef M, Otten MH, van Woensel JBM, Bem RA. Interobserver Agreement on Clinical Judgment of Work of Breathing in Spontaneously Breathing Children in the Pediatric Intensive Care Unit. J Pediatr Intensive Care 2019; 9:34-39. [PMID: 31984155 DOI: 10.1055/s-0039-1697679] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Accepted: 08/21/2019] [Indexed: 01/15/2023] Open
Abstract
Clinical assessment of the work of breathing (WOB) remains a cornerstone in respiratory support decision-making in the pediatric intensive care unit (PICU). In this study, we determined the interobserver agreement of 30 observers (PICU physicians and nurses) on WOB and multiple signs of effort of breathing in 10 spontaneously breathing children admitted to the PICU. By reliability analysis, the agreement on overall WOB was poor to moderate, and only three separate signs of effort of breathing (breathing rate, stridor, and grunting) showed moderate-to-good interobserver reliability. We conclude that the interobserver agreement on the clinical WOB judgment among PICU physicians and nurses is low.
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Affiliation(s)
- Marcel G de Groot
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marjorie de Neef
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Marieke H Otten
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Job B M van Woensel
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Reinout A Bem
- Pediatric Intensive Care Unit, Emma Children's Hospital, Amsterdam University Medical Centers, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
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9
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Donnelly D, Everard ML. 'Dry' and 'wet' cough: how reliable is parental reporting? BMJ Open Respir Res 2019; 6:e000375. [PMID: 31178996 PMCID: PMC6530544 DOI: 10.1136/bmjresp-2018-000375] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 03/22/2019] [Accepted: 03/22/2019] [Indexed: 11/10/2022] Open
Abstract
Introduction Chronic cough in childhood is common and causes much parental anxiety. Eliciting a diagnosis can be difficult as it is a non-specific symptom indicating airways inflammation and this may be due to a variety of aetiologies. A key part of assessment is obtaining an accurate cough history. It has previously been shown that parental reporting of 'wheeze' is frequently inaccurate. This study aimed to determine whether parental reporting of the quality of a child's cough is likely to be accurate. Methods Parents of 48 'new' patients presenting to a respiratory clinic with chronic cough were asked to describe the nature of their child's cough. They were then shown video clips of different types of cough using age-appropriate examples, and their initial report was compared with the types of cough chosen from the video. Results In a quarter of cases, the parents chose a video clip of a 'dry' or 'wet' cough having given the opposite description. In a further 20% parents chose examples of both 'dry' and 'wet' coughs despite having used only one descriptor. Discussion While the characteristics of a child's cough carry important information that may be helpful in reaching a diagnosis, clinicians should interpret parental reporting of the nature of a child's cough with some caution in that one person's 'dry' cough may very well be another person's 'wet' cough.
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Affiliation(s)
- Deirdre Donnelly
- Respiratory Medicine, Sheffield Children's Hospital, Sheffield, UK
| | - Mark L Everard
- School of Paediatrics and Child Health, University of Western Australia, Perth, Western Australia, Australia
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10
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Langton L, Bonfield A, Roland D. Inter-rater reliability in the Paediatric Observation Priority Score (POPS). Arch Dis Child 2018; 103:458-462. [PMID: 29330169 DOI: 10.1136/archdischild-2017-314165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 12/06/2017] [Accepted: 12/08/2017] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The primary objective of this study was to determine the level of inter-rater reliability between nursing staff for the Paediatric Observation Priority Score (POPS). DESIGN Retrospective observational study. SETTING Single-centre paediatric emergency department. PARTICIPANTS 12 participants from a convenience sample of 21 nursing staff. INTERVENTIONS Participants were shown video footage of three pre-recorded paediatric assessments and asked to record their own POPS for each child. The participants were blinded to the original, in-person POPS. Further data were gathered in the form of a questionnaire to determine the level of training and experience the candidate had using the POPS score prior to undertaking this study. MAIN OUTCOME MEASURES Inter-rater reliability among participants scoring of the POPS. RESULTS Overall kappa value for case 1 was 0.74 (95% CI 0.605 to 0.865), case 2 was 1 (perfect agreement) and case 3 was 0.66 (95% CI 0.58 to 0.744). CONCLUSION This study suggests there is good inter-rater reliability between different nurses' use of POPS in assessing sick children in the emergency department.
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Affiliation(s)
- Lisa Langton
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Adam Bonfield
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Damian Roland
- Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, University Hospitals of Leicester NHS Trust, Leicester, UK.,SAPPHIRE Group, Health Services, University of Leicester, Leicester, UK
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11
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Crawley J, Prosperi C, Baggett HC, Brooks WA, Deloria Knoll M, Hammitt LL, Howie SRC, Kotloff KL, Levine OS, Madhi SA, Murdoch DR, O'Brien KL, Thea DM, Awori JO, Bunthi C, DeLuca AN, Driscoll AJ, Ebruke BE, Goswami D, Hidgon MM, Karron RA, Kazungu S, Kourouma N, Mackenzie G, Moore DP, Mudau A, Mwale M, Nahar K, Park DE, Piralam B, Seidenberg P, Sylla M, Feikin DR, Scott JAG. Standardization of Clinical Assessment and Sample Collection Across All PERCH Study Sites. Clin Infect Dis 2018; 64:S228-S237. [PMID: 28575355 PMCID: PMC5447838 DOI: 10.1093/cid/cix077] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Background.
Variable adherence to standardized case definitions, clinical procedures, specimen collection techniques, and laboratory methods has complicated the interpretation of previous multicenter pneumonia etiology studies. To circumvent these problems, a program of clinical standardization was embedded in the Pneumonia Etiology Research for Child Health (PERCH) study. Methods. Between March 2011 and August 2013, standardized training on the PERCH case definition, clinical procedures, and collection of laboratory specimens was delivered to 331 clinical staff at 9 study sites in 7 countries (The Gambia, Kenya, Mali, South Africa, Zambia, Thailand, and Bangladesh), through 32 on-site courses and a training website. Staff competency was assessed throughout 24 months of enrollment with multiple-choice question (MCQ) examinations, a video quiz, and checklist evaluations of practical skills. Results. MCQ evaluation was confined to 158 clinical staff members who enrolled PERCH cases and controls, with scores obtained for >86% of eligible staff at each time-point. Median scores after baseline training were ≥80%, and improved by 10 percentage points with refresher training, with no significant intersite differences. Percentage agreement with the clinical trainer on the presence or absence of clinical signs on video clips was high (≥89%), with interobserver concordance being substantial to high (AC1 statistic, 0.62–0.82) for 5 of 6 signs assessed. Staff attained median scores of >90% in checklist evaluations of practical skills. Conclusions. Satisfactory clinical standardization was achieved within and across all PERCH sites, providing reassurance that any etiological or clinical differences observed across the study sites are true differences, and not attributable to differences in application of the clinical case definition, interpretation of clinical signs, or in techniques used for clinical measurements or specimen collection.
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Affiliation(s)
- Jane Crawley
- Centre for Tropical Medicine and Global Health, Nuffield Department of Clinical Medicine, University of Oxford, United Kingdom
| | - Christine Prosperi
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Henry C Baggett
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi.,Division of Global Health Protection, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - W Abdullah Brooks
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab.,Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Maria Deloria Knoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Laura L Hammitt
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Stephen R C Howie
- Medical Research Council Unit, Basse, The Gambia.,Department of Pediatrics, University of Auckland, and.,Centre for International Health, University of Otago, Dunedin, New Zealand
| | - Karen L Kotloff
- Division of Infectious Disease and Tropical Pediatrics, Department of Pediatrics, Center for Vaccine Development, Institute of Global Health, University of Maryland School of Medicine, Baltimore, and
| | - Orin S Levine
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Bill & Melinda Gates Foundation, Seattle, Washington
| | - Shabir A Madhi
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, and.,Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | - David R Murdoch
- Department of Pathology, University of Otago, and.,Microbiology Unit, Canterbury Health Laboratories, Christchurch, New Zealand
| | - Katherine L O'Brien
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Donald M Thea
- Center for Global Health and Development, Boston University School of Public Health, Massachusetts, and Departments of
| | - Juliet O Awori
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Charatdao Bunthi
- Global Disease Detection Center, Thailand Ministry of Public Health-US Centers for Disease Control and Prevention Collaboration, Nonthaburi
| | - Andrea N DeLuca
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Epidemiology and
| | - Amanda J Driscoll
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | | | - Doli Goswami
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab
| | - Melissa M Hidgon
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Ruth A Karron
- International Health, Center for Immunization Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Sidi Kazungu
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi
| | - Nana Kourouma
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako
| | - Grant Mackenzie
- Medical Research Council Unit, Basse, The Gambia.,Murdoch Childrens Research Institute, Melbourne, Australia.,London School of Hygiene & Tropical Medicine, United Kingdom
| | - David P Moore
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, and.,Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa.,Department of Paediatrics and Child Health, Chris Hani Baragwanath Academic Hospital and University of the Witwatersrand, South Africa
| | - Azwifari Mudau
- Medical Research Council, Respiratory and Meningeal Pathogens Research Unit, and.,Department of Science and Technology/National Research Foundation, Vaccine Preventable Diseases Unit, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Kamrun Nahar
- International Centre for Diarrhoeal Disease Research, Bangladesh (icddr,b), Dhaka and Matlab
| | - Daniel E Park
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Milken Institute School of Public Health, Department of Epidemiology and Biostatistics, George Washington University, Washington, District of Columbia
| | | | - Phil Seidenberg
- Center for Global Health and Development, Boston University School of Public Health, Massachusetts, and Departments of.,Department of Emergency Medicine, University of New Mexico, Albuquerque, and
| | - Mamadou Sylla
- Centre pour le Développement des Vaccins (CVD-Mali), Bamako
| | - Daniel R Feikin
- Department of International Health, International Vaccine Access Center, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.,Division of Viral Diseases, National Center for Immunizations and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia; and
| | - J Anthony G Scott
- Kenya Medical Research Institute-Wellcome Trust Research Programme, Kilifi.,Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, United Kingdom
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12
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Sarna M, Lambert SB, Sloots TP, Whiley DM, Alsaleh A, Mhango L, Bialasiewicz S, Wang D, Nissen MD, Grimwood K, Ware RS. Viruses causing lower respiratory symptoms in young children: findings from the ORChID birth cohort. Thorax 2017; 73:969-979. [PMID: 29247051 PMCID: PMC6166599 DOI: 10.1136/thoraxjnl-2017-210233] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Revised: 10/26/2017] [Accepted: 11/20/2017] [Indexed: 11/03/2022]
Abstract
INTRODUCTION Viral acute respiratory infections (ARIs) cause substantial child morbidity. Sensitive molecular-based assays aid virus detection, but the clinical significance of positive tests remains uncertain as some viruses may be found in both acutely ill and healthy children. We describe disease-pathogen associations of respiratory viruses and quantify virus-specific attributable risk of ARIs in healthy children during the first 2 years of life. METHODS One hundred fifty-eight term newborn babies in Brisbane, Australia, were recruited progressively into a longitudinal, community-based, birth cohort study conducted between September 2010 and October 2014. A daily tick-box diary captured predefined respiratory symptoms from birth until their second birthday. Weekly parent-collected nasal swabs were batch-tested for 17 respiratory viruses by PCR assays, allowing calculation of virus-specific attributable fractions in the exposed (AFE) to determine the proportion of virus-positive children whose ARI symptoms could be attributed to that particular virus. RESULTS Of 8100 nasal swabs analysed, 2646 (32.7%) were virus-positive (275 virus codetections, 3.4%), with human rhinoviruses accounting for 2058/2646 (77.8%) positive swabs. Viruses were detected in 1154/1530 (75.4%) ARI episodes and in 984/4308 (22.8%) swabs from asymptomatic periods. Respiratory syncytial virus (AFE: 68% (95% CI 45% to 82%)) and human metapneumovirus (AFE: 69% (95% CI 43% to 83%)) were strongly associated with higher risk of lower respiratory symptoms. DISCUSSION The strong association of respiratory syncytial virus and human metapneumovirus with ARIs and lower respiratory symptoms in young children managed within the community indicates successful development of vaccines against these two viruses should provide substantial health benefits.
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Affiliation(s)
- Mohinder Sarna
- School of Public Health, The University of Queensland, Brisbane, Australia.,UQ Child Health Research Centre, The University of Queensland, Brisbane, Australia
| | - Stephen B Lambert
- UQ Child Health Research Centre, The University of Queensland, Brisbane, Australia.,Queensland Paediatric Infectious Diseases Laboratory, Children's Health Queensland, Brisbane, Australia
| | - Theo P Sloots
- UQ Child Health Research Centre, The University of Queensland, Brisbane, Australia.,Queensland Paediatric Infectious Diseases Laboratory, Children's Health Queensland, Brisbane, Australia
| | - David M Whiley
- UQ Child Health Research Centre, The University of Queensland, Brisbane, Australia.,University of Queensland Centre for Clinical Research, The University of Queensland, Brisbane, Queensland, Australia
| | - Asma Alsaleh
- Department of Botany and Microbiology, King Saud University, Riyadh, Saudi Arabia
| | - Lebogang Mhango
- UQ Child Health Research Centre, The University of Queensland, Brisbane, Australia.,Queensland Paediatric Infectious Diseases Laboratory, Children's Health Queensland, Brisbane, Australia
| | - Seweryn Bialasiewicz
- UQ Child Health Research Centre, The University of Queensland, Brisbane, Australia.,Queensland Paediatric Infectious Diseases Laboratory, Children's Health Queensland, Brisbane, Australia
| | - David Wang
- School of Medicine, Washington University in St Louis, St Louis, Missouri, USA
| | - Michael D Nissen
- UQ Child Health Research Centre, The University of Queensland, Brisbane, Australia.,Queensland Paediatric Infectious Diseases Laboratory, Children's Health Queensland, Brisbane, Australia
| | - Keith Grimwood
- School of Medicine and Menzies Health Institute Queensland, Griffith University, Brisbane, Australia.,Departments of Infectious Diseases and Paediatrics, Gold Coast Health, Gold Coast, Australia
| | - Robert S Ware
- School of Public Health, The University of Queensland, Brisbane, Australia.,UQ Child Health Research Centre, The University of Queensland, Brisbane, Australia.,Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
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13
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Justicia-Grande AJ, Pardo Seco J, Rivero Calle I, Martinón-Torres F. Clinical respiratory scales: which one should we use? Expert Rev Respir Med 2017; 11:925-943. [PMID: 28974118 DOI: 10.1080/17476348.2017.1387052] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
INTRODUCTION There are countless clinical respiratory scales for acute dyspnoea. Most healthcare professionals choose one based on previous personal experience or following local practice, unaware of the implications of their choice. The lack of critical comparisons between those different tools has been a widespread problem that only recently has begun to be addressed via score validation studies. Here we try to assess and compare the quality criteria of measurement properties of acute dyspnoea scores. Areas covered: A literature review was conducted by searching the PubMed database. Forty-five documents were deemed eligible as they reported the use or building of clinical scales, using at least two parameters, and applied these to an acute episode of respiratory dyspnoea. Our primary focus was the description of the validity, reliability and utility of 41 suitable scoring instruments. Differences in sample selection, study design, rater profiles and potential methodological shortcomings were also addressed. Expert commentary: All acute dyspnoea scores lack complete validation. In particular, the areas of measurement error and interpretability have not been addressed correctly by any of the tools reviewed. Frequent modification of pre-existing scores (in items composition and/or name), differences in study design and discrepancies in reviewed sources also hinder the search for an adequate tool.
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Affiliation(s)
- Antonio José Justicia-Grande
- a Translational Pediatrics and Infectious Diseases, Department of Pediatrics , Hospital Clínico Universitario de Santiago de Compostela , A Coruña , Spain.,b Healthcare Research Institute , Instituto de Investigación Sanitaria de Santiago, GENVIP group , Santiago de Compostela, A Coruña , Spain
| | - Jacobo Pardo Seco
- b Healthcare Research Institute , Instituto de Investigación Sanitaria de Santiago, GENVIP group , Santiago de Compostela, A Coruña , Spain
| | - Irene Rivero Calle
- a Translational Pediatrics and Infectious Diseases, Department of Pediatrics , Hospital Clínico Universitario de Santiago de Compostela , A Coruña , Spain.,b Healthcare Research Institute , Instituto de Investigación Sanitaria de Santiago, GENVIP group , Santiago de Compostela, A Coruña , Spain
| | - Federico Martinón-Torres
- a Translational Pediatrics and Infectious Diseases, Department of Pediatrics , Hospital Clínico Universitario de Santiago de Compostela , A Coruña , Spain.,b Healthcare Research Institute , Instituto de Investigación Sanitaria de Santiago, GENVIP group , Santiago de Compostela, A Coruña , Spain
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14
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Johnson MD, Nkoy FL, Sheng X, Greene T, Stone BL, Garvin J. Direct concurrent comparison of multiple pediatric acute asthma scoring instruments. J Asthma 2017; 54:741-753. [PMID: 27831833 PMCID: PMC5425314 DOI: 10.1080/02770903.2016.1258081] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 11/02/2016] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Appropriate delivery of Emergency Department (ED) treatment to children with acute asthma requires clinician assessment of acute asthma severity. Various clinical scoring instruments exist to standardize assessment of acute asthma severity in the ED, but their selection remains arbitrary due to few published direct comparisons of their properties. Our objective was to test the feasibility of directly comparing properties of multiple scoring instruments in a pediatric ED. METHODS Using a novel approach supported by a composite data collection form, clinicians categorized elements of five scoring instruments before and after initial treatment for 48 patients 2-18 years of age with acute asthma seen at the ED of a tertiary care pediatric hospital ED from August to December 2014. Scoring instruments were compared for inter-rater reliability between clinician types and their ability to predict hospitalization. RESULTS Inter-rater reliability between clinician types was not different between instruments at any point and was lower (weighted kappa range 0.21-0.55) than values reported elsewhere. Predictive ability of most instruments for hospitalization was higher after treatment than before treatment (p < 0.05) and may vary between instruments after treatment (p = 0.054). CONCLUSIONS We demonstrate the feasibility of comparing multiple clinical scoring instruments simultaneously in ED clinical practice. Scoring instruments had higher predictive ability for hospitalization after treatment than before treatment and may differ in their predictive ability after initial treatment. Definitive conclusions about the best instrument or meaningful comparison between instruments will require a study with a larger sample size.
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Affiliation(s)
- Michael D. Johnson
- Department of Pediatrics, University of Utah School of Medicine, 100
N Mario Capecchi Drive, Salt Lake City, UT 84113, USA
| | - Flory L. Nkoy
- Department of Pediatrics, University of Utah School of Medicine, 100
N Mario Capecchi Drive, Salt Lake City, UT 84113, USA
- Department of Biomedical Informatics, University of Utah School of
Medicine, Suite 140, 421 Wakara Way, Salt Lake City, UT 84108, USA
| | - Xiaoming Sheng
- Department of Pediatrics, University of Utah School of Medicine, 100
N Mario Capecchi Drive, Salt Lake City, UT 84113, USA
| | - Tom Greene
- Department of Population Health Sciences, University of Utah School
of Medicine, 295 Chipeta Way, Salt Lake City, UT 84108, USA
| | - Bryan L. Stone
- Department of Pediatrics, University of Utah School of Medicine, 100
N Mario Capecchi Drive, Salt Lake City, UT 84113, USA
| | - Jennifer Garvin
- Department of Biomedical Informatics, University of Utah School of
Medicine, Suite 140, 421 Wakara Way, Salt Lake City, UT 84108, USA
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15
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Florin TA, Ambroggio L, Brokamp C, Rattan MS, Crotty EJ, Kachelmeyer A, Ruddy RM, Shah SS. Reliability of Examination Findings in Suspected Community-Acquired Pneumonia. Pediatrics 2017; 140:peds.2017-0310. [PMID: 28835381 PMCID: PMC5574720 DOI: 10.1542/peds.2017-0310] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/01/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The authors of national guidelines emphasize the use of history and examination findings to diagnose community-acquired pneumonia (CAP) in outpatient children. Little is known about the interrater reliability of the physical examination in children with suspected CAP. METHODS This was a prospective cohort study of children with suspected CAP presenting to a pediatric emergency department from July 2013 to May 2016. Children aged 3 months to 18 years with lower respiratory signs or symptoms who received a chest radiograph were included. We excluded children hospitalized ≤14 days before the study visit and those with a chronic medical condition or aspiration. Two clinicians performed independent examinations and completed identical forms reporting examination findings. Interrater reliability for each finding was reported by using Fleiss' kappa (κ) for categorical variables and intraclass correlation coefficient (ICC) for continuous variables. RESULTS No examination finding had substantial agreement (κ/ICC > 0.8). Two findings (retractions, wheezing) had moderate to substantial agreement (κ/ICC = 0.6-0.8). Nine findings (abdominal pain, pleuritic pain, nasal flaring, skin color, overall impression, cool extremities, tachypnea, respiratory rate, and crackles/rales) had fair to moderate agreement (κ/ICC = 0.4-0.6). Eight findings (capillary refill time, cough, rhonchi, head bobbing, behavior, grunting, general appearance, and decreased breath sounds) had poor to fair reliability (κ/ICC = 0-0.4). Only 3 examination findings had acceptable agreement, with the lower 95% confidence limit >0.4: wheezing, retractions, and respiratory rate. CONCLUSIONS In this study, we found fair to moderate reliability of many findings used to diagnose CAP. Only 3 findings had acceptable levels of reliability. These findings must be considered in the clinical management and research of pediatric CAP.
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Affiliation(s)
- Todd A. Florin
- Divisions of Emergency Medicine,,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Lilliam Ambroggio
- Biostatistics and Epidemiology,,Hospital Medicine, and,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | - Mantosh S. Rattan
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Eric J. Crotty
- Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio; and,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | - Richard M. Ruddy
- Divisions of Emergency Medicine,,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Samir S. Shah
- Divisions of Emergency Medicine,,Hospital Medicine, and,Infectious Diseases, and,Department of Pediatrics, College of Medicine, University of Cincinnati, Cincinnati, Ohio
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16
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Sarna M, Ware RS, Sloots TP, Nissen MD, Grimwood K, Lambert SB. The burden of community-managed acute respiratory infections in the first 2-years of life. Pediatr Pulmonol 2016; 51:1336-1346. [PMID: 27228308 DOI: 10.1002/ppul.23480] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 04/14/2016] [Accepted: 05/02/2016] [Indexed: 11/05/2022]
Abstract
BACKGROUND Contemporary information on acute respiratory infections (ARIs) in children is based on hospital cohorts, primary healthcare presentations, and high-risk birth cohort studies. We describe the burden and determinants of symptomatic episodes of ARIs in unselected healthy infants in the first 2-years of life. METHODS One hundred and fifty-four infants from subtropical Brisbane, Australia participated in a longitudinal, community-based birth cohort study. A daily tick-box diary captured pre-defined respiratory symptoms. Parents also completed a burden diary, recording family physician and hospital visits, and antibiotic use. RESULTS Participants contributed 88,032 child-days (78.2% of expected), of which 17,316 (19.7%) days were symptomatic during 1,651 ARI episodes: incidence rate 0.56 ARIs per child-month (95%CI: 0.54, 0.59). Runny nose (14,220 days; 6.0-days median duration) and dry cough (6,880 days; 4.0-days median duration) were reported most frequently. Overall, 955 burden diaries recorded 455 family physician visits (1-8 visits per ARI) and 48 hospital presentations, including six hospital admissions. Antibiotics were prescribed on 209 occasions (21.9% of ARI episodes where burden diary submitted). Increasing age, non-summer seasons, and attendance at childcare were associated with an increased risk of ARI. CONCLUSIONS ARIs are a common cause of morbidity in the first 2-years of life, with children experiencing 13 discrete ARI episodes and almost 5-months of respiratory symptoms. Most ARIs are managed in the community by parents and family physicians. Antibiotic prescribing remains common for ARIs in young children. Secular societal changes, including greater use of childcare in early childhood, may have maintained the high ARI incidence in this age-group. Pediatr Pulmonol. 2016;51:1336-1346. © 2016 Wiley Periodicals, Inc.
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Affiliation(s)
- Mohinder Sarna
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.,Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Robert S Ware
- School of Public Health, The University of Queensland, Brisbane, Queensland, Australia.,Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Theo P Sloots
- Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.,Queensland Pediatric Infectious Diseases Laboratory, Centre for Children's Health Research, Children's Health Queensland, Brisbane, Queensland, Australia
| | - Michael D Nissen
- Child Health Research Centre, School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Keith Grimwood
- Menzies Health Institute Queensland, Griffith University and Gold Coast Health, Gold Coast, Queensland, Australia
| | - Stephen B Lambert
- Queensland Pediatric Infectious Diseases Laboratory, Centre for Children's Health Research, Children's Health Queensland, Brisbane, Queensland, Australia.,Communicable Diseases Branch, Queensland Health, Brisbane, Queensland, Australia
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17
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Clinical Scores for Dyspnoea Severity in Children: A Prospective Validation Study. PLoS One 2016; 11:e0157724. [PMID: 27382963 PMCID: PMC4934692 DOI: 10.1371/journal.pone.0157724] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Accepted: 06/05/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In acute dyspnoeic children, assessment of dyspnoea severity and treatment response is frequently based on clinical dyspnoea scores. Our study aim was to validate five commonly used paediatric dyspnoea scores. METHODS Fifty children aged 0-8 years with acute dyspnoea were clinically assessed before and after bronchodilator treatment, a subset of 27 children were videotaped and assessed twice by nine observers. The observers scored clinical signs necessary to calculate the Asthma Score (AS), Asthma Severity Score (ASS), Clinical Asthma Evaluation Score 2 (CAES-2), Pediatric Respiratory Assessment Measure (PRAM) and respiratory rate, accessory muscle use, decreased breath sounds (RAD). RESULTS A total of 1120 observations were used to assess fourteen measurement properties within domains of validity, reliability and utility. All five dyspnoea scores showed overall poor results, scoring insufficiently on more than half of the quality criteria for measurement properties. The AS and PRAM were the most valid with good values on six and moderate values on three properties. Poor results were mainly due to insufficient measurement properties in the validity and reliability domains whereas utility properties were moderate to good in all scores. CONCLUSION This study shows that commonly used dyspnoea scores show insufficient validity and reliability to allow for clinical use without caution.
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18
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Melbye H, Garcia-Marcos L, Brand P, Everard M, Priftis K, Pasterkamp H. Wheezes, crackles and rhonchi: simplifying description of lung sounds increases the agreement on their classification: a study of 12 physicians' classification of lung sounds from video recordings. BMJ Open Respir Res 2016; 3:e000136. [PMID: 27158515 PMCID: PMC4854017 DOI: 10.1136/bmjresp-2016-000136] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2016] [Revised: 04/08/2016] [Accepted: 04/10/2016] [Indexed: 12/04/2022] Open
Abstract
Background The European Respiratory Society (ERS) lung sounds repository contains 20 audiovisual recordings of children and adults. The present study aimed at determining the interobserver variation in the classification of sounds into detailed and broader categories of crackles and wheezes. Methods Recordings from 10 children and 10 adults were classified into 10 predefined sounds by 12 observers, 6 paediatricians and 6 doctors for adult patients. Multirater kappa (Fleiss' κ) was calculated for each of the 10 adventitious sounds and for combined categories of sounds. Results The majority of observers agreed on the presence of at least one adventitious sound in 17 cases. Poor to fair agreement (κ<0.40) was usually found for the detailed descriptions of the adventitious sounds, whereas moderate to good agreement was reached for the combined categories of crackles (κ=0.62) and wheezes (κ=0.59). The paediatricians did not reach better agreement on the child cases than the family physicians and specialists in adult medicine. Conclusions Descriptions of auscultation findings in broader terms were more reliably shared between observers compared to more detailed descriptions.
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Affiliation(s)
- Hasse Melbye
- Faculty of Health Sciences, General Practice Research Unit , UIT the Arctic University of Norway , Tromsø , Norway
| | - Luis Garcia-Marcos
- Pediatric Respiratory and Allergy Units, Arrixaca University Children's Hospital, University of Murcia, Murcia, Spain; IMIB-Arrixaca Biohealth Research Institute, Murcia, Spain
| | - Paul Brand
- Princess Amalia Children's Center, Isala Hospital, Zwolle, The Netherlands; Postgraduate School of Medicine, University Medical Centre and University of Groningen, Groningen, The Netherlands
| | - Mark Everard
- School of Paediatrics, University of Western Australia, Princess Margaret Hospital , Subiaco, Western Australia , Australia
| | - Kostas Priftis
- Children's Respiratory and Allergy Unit, Third Dept of Paediatrics , "Attikon" Hospital, University of Athens Medical School , Athens , Greece
| | - Hans Pasterkamp
- Section of Respirology, Dept of Pediatrics and Child Health , University of Manitoba , Winnipeg, Manitoba , Canada
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19
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Clouse BJ, Jadcherla SR, Slaughter JL. Systematic Review of Inhaled Bronchodilator and Corticosteroid Therapies in Infants with Bronchopulmonary Dysplasia: Implications and Future Directions. PLoS One 2016; 11:e0148188. [PMID: 26840339 PMCID: PMC4740433 DOI: 10.1371/journal.pone.0148188] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2015] [Accepted: 01/14/2016] [Indexed: 12/03/2022] Open
Abstract
Background There is much debate surrounding the use of inhaled bronchodilators and corticosteroids for infants with bronchopulmonary dysplasia (BPD). Objective The objective of this systematic review was to identify strengths and knowledge gaps in the literature regarding inhaled therapies in BPD and guide future research to improve long-termoutcomes. Methods The databases of Academic Search Complete, CINAHL, PUBMED/MEDLINE, and Scopus were searched for studies that evaluated both acute and long-term clinical outcomes related to the delivery and therapeutic efficacy of inhaled beta-agonists, anticholinergics and corticosteroids in infants with developing and/or established BPD. Results Of 181 articles, 22 met inclusion criteria for review. Five evaluated beta-agonist therapies (n = 84, weighted gestational age (GA) of 27.1(26–30) weeks, weighted birth weight (BW) of 974(843–1310) grams, weighted post menstrual age (PMA) of 34.8(28–39) weeks, and weighted age of 53(15–86) days old at the time of evaluation). Fourteen evaluated inhaled corticosteroids (n = 2383, GA 26.2(26–29) weeks, weighted BW of 853(760–1114) grams, weighted PMA of 27.0(26–31) weeks, and weighted age of 6(0–45) days old at time of evaluation). Three evaluated combination therapies (n = 198, weighted GA of 27.8(27–29) weeks, weighted BW of 1057(898–1247) grams, weighted PMA of 30.7(29–45) weeks, and age 20(10–111) days old at time of evaluation). Conclusion Whether inhaled bronchodilators and inhaled corticosteroids improve long-term outcomes in BPD remains unclear. Literature regarding these therapies mostly addresses evolving BPD. There appears to be heterogeneity in treatment responses, and may be related to varying modes of administration. Further research is needed to evaluate inhaled therapies in infants with severe BPD. Such investigations should focus on appropriate definitions of disease and subject selection, timing of therapies, and new drugs, devices and delivery methods as compared to traditional methods across all modalities of respiratory support, in addition to the assessment of long-term outcomes of initial responders.
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Affiliation(s)
- Brian J. Clouse
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- * E-mail:
| | - Sudarshan R. Jadcherla
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Division of Neonatology, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
| | - Jonathan L. Slaughter
- Center for Perinatal Research, The Research Institute at Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- Division of Neonatology, Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio, United States of America
- The Ohio State University College of Medicine, Columbus, Ohio, United States of America
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Marangu D, Kovacs S, Walson J, Bonhoeffer J, Ortiz JR, John-Stewart G, Horne DJ. Wheeze as an adverse event in pediatric vaccine and drug randomized controlled trials: A systematic review. Vaccine 2015; 33:5333-5341. [PMID: 26319071 PMCID: PMC4743983 DOI: 10.1016/j.vaccine.2015.08.060] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2015] [Revised: 08/08/2015] [Accepted: 08/17/2015] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Wheeze is an important sign indicating a potentially severe adverse event in vaccine and drug trials, particularly in children. However, there are currently no consensus definitions of wheeze or associated respiratory compromise in randomized controlled trials (RCTs). OBJECTIVE To identify definitions and severity grading scales of wheeze as an adverse event in vaccine and drug RCTs enrolling children <5 years and to determine their diagnostic performance based on sensitivity, specificity and inter-observer agreement. METHODS We performed a systematic review of electronic databases and reference lists with restrictions for trial settings, English language and publication date ≥1970. Wheeze definitions and severity grading were abstracted and ranked by a diagnostic certainty score based on sensitivity, specificity and inter-observer agreement. RESULTS Of 1205 articles identified using our broad search terms, we identified 58 eligible trials conducted in 38 countries, mainly in high-income settings. Vaccines made up the majority (90%) of interventions, particularly influenza vaccines (65%). Only 15 trials provided explicit definitions of wheeze. Of 24 studies that described severity, 11 described wheeze severity in the context of an explicit wheeze definition. The remaining 13 studies described wheeze severity where wheeze was defined as part of a respiratory illness or a wheeze equivalent. Wheeze descriptions were elicited from caregiver reports (14%), physical examination by a health worker (45%) or a combination (41%). There were 21/58 studies in which wheeze definitions included combined caregiver report and healthcare worker assessment. The use of these two methods appeared to have the highest combined sensitivity and specificity. CONCLUSION Standardized wheeze definitions and severity grading scales for use in pediatric vaccine or drug trials are lacking. Standardized definitions of wheeze are needed for assessment of possible adverse events as new vaccines and drugs are evaluated.
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Affiliation(s)
- Diana Marangu
- Department of Pediatrics and Child Health, University of Nairobi, Nairobi, Kenya.
| | - Stephanie Kovacs
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Judd Walson
- Department of Epidemiology, University of Washington, Seattle, WA, United States; Department of Medicine, University of Washington, Seattle, WA, United States; Department of Global Health, University of Washington, Seattle, WA, United States; Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Jan Bonhoeffer
- Brighton Collaboration Foundation, Basel, Switzerland; University of Basel Children's Hospital, Basel, Switzerland
| | - Justin R Ortiz
- Initiative for Vaccine Research (IVR), World Health Organization, Geneva, Switzerland
| | - Grace John-Stewart
- Department of Epidemiology, University of Washington, Seattle, WA, United States; Department of Medicine, University of Washington, Seattle, WA, United States; Department of Global Health, University of Washington, Seattle, WA, United States
| | - David J Horne
- Department of Medicine, University of Washington, Seattle, WA, United States; Department of Global Health, University of Washington, Seattle, WA, United States
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Powell CVE. How accurate is the clinical assessment of acute dyspnoea and wheeze in children? Arch Dis Child 2015. [PMID: 26203121 DOI: 10.1136/archdischild-2015-308717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Roland D, Matheson D, Taub N, Coats T, Lakhanpaul M. Is perception of quality more important than technical quality in patient video cases? BMC MEDICAL EDUCATION 2015; 15:132. [PMID: 26268319 PMCID: PMC4542110 DOI: 10.1186/s12909-015-0419-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2015] [Accepted: 07/29/2015] [Indexed: 06/04/2023]
Abstract
BACKGROUND The use of video cases to demonstrate key signs and symptoms in patients (patient video cases or PVCs) is a rapidly expanding field. The aims of this study were to evaluate whether the technical quality, or judgement of quality, of a video clip influences a paediatrician's judgment on acuity of the case and assess the relationship between perception of quality and the technical quality of a selection of video clips. METHODS Participants (12 senior consultant paediatricians attending an examination workshop) individually categorised 28 PVCs into one of 3 possible acuities and then described the quality of the image seen. The PVCs had been converted into four different technical qualities (differing bit rates ranging from excellent to low quality). RESULTS Participants' assessment of quality and the actual industry standard of the PVC were independent (333 distinct observations, spearmans rho = 0.0410, p = 0.4564). Agreement between actual acuity and participants' judgement was generally good at higher acuities but moderate at medium/low acuities of illness (overall correlation 0.664). Perception of the quality of the clip was related to correct assignment of acuity regardless of the technical quality of the clip (number of obs = 330, z = 2.07, p = 0.038). CONCLUSIONS It is important to benchmark PVCs prior to use in learning resources as experts may not agree on the information within, or quality of, the clip. It appears, although PVCs may be beneficial in a pedagogical context, the perception of quality of clip may be an important determinant of an expert's decision making.
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Affiliation(s)
- Damian Roland
- Department of Health Sciences, SAPPHIRE Group, University of Leicester, 22-28 Princess Road West, Leicester, LE1 6TP, UK.
- Paediatric Emergency Medicine Leicester Academic Group, University Hospitals of Leicester NHS Trust, Leicester Royal Infirmary, Leicester, LE1 5WW, UK.
| | - David Matheson
- Carnegie Faculty, Leeds Beckett University, Leeds, LS1 3HE, UK.
| | - Nick Taub
- Department of Health Sciences, SAPPHIRE Group, University of Leicester, 22-28 Princess Road West, Leicester, LE1 6TP, UK.
| | - Tim Coats
- Emergency Medicine Academic Group. Cardiovascular Sciences, Leicester University, Leicester, LE3 9QP, UK.
| | - Monica Lakhanpaul
- Emergency Medicine Academic Group. Cardiovascular Sciences, Leicester University, Leicester, LE3 9QP, UK.
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