Field testing two existing, standardized respiratory severity scores (LIBSS and ReSViNET) in infants presenting with acute respiratory illness to tertiary hospitals in Rwanda – a validation and inter-rater reliability study

<h4>Introduction</h4> There is a substantial burden of respiratory disease in infants in the sub-Saharan Africa region. Many health care providers (HCPs) that initially receive infants with respiratory distress may not be adequately skilled to differentiate between mild, moderate and sev...

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Autores principales:	Boniface Hakizimana, Edgar Kalimba, Augustin Ndatinya, Gemma Saint, Clare van Miert, Peter Thomas Cartledge
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/3fbc7f834c2243acab265a96569c8752
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spelling	oai:doaj.org-article:3fbc7f834c2243acab265a96569c87522021-11-11T07:14:38ZField testing two existing, standardized respiratory severity scores (LIBSS and ReSViNET) in infants presenting with acute respiratory illness to tertiary hospitals in Rwanda – a validation and inter-rater reliability study1932-6203https://doaj.org/article/3fbc7f834c2243acab265a96569c87522021-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8568200/?tool=EBIhttps://doaj.org/toc/1932-6203<h4>Introduction</h4> There is a substantial burden of respiratory disease in infants in the sub-Saharan Africa region. Many health care providers (HCPs) that initially receive infants with respiratory distress may not be adequately skilled to differentiate between mild, moderate and severe respiratory symptoms, which may contribute to poor management and outcome. Therefore, respiratory severity scores have the potential to contributing to address this gap. <h4>Objectives</h4> to field-test the use of two existing standardized bronchiolitis severity scores (LIBSS and ReSViNET) in a population of Rwandan infants (1–12 months) presenting with respiratory illnesses to urban, tertiary, pediatric hospitals and to assess the severity of respiratory distress in these infants and the treatments used. <h4>Methods</h4> A cross-sectional, validation study, was conducted in four tertiary hospitals in Rwanda. Infants presenting with difficulty in breathing were included. The LIBSS and ReSViNET scores were independently employed by nurses and residents to assess the severity of disease in each infant. <h4>Results</h4> 100 infants were recruited with a mean age of seven months. Infants presented with pneumonia (n = 51), bronchiolitis (n = 36) and other infectious respiratory illnesses (n = 13). Thirty-three infants had severe disease and survival was 94% using nurse applied LIBSS. Regarding inter-rater reliability, the intra-class correlation coefficient (ICC) for LIBSS and ReSViNET between nurses and residents was 0.985 (95% CI: 0.98–0.99) and 0.980 (0.97–0.99). The convergent validity (Pearson’s correlation) between LIBSS and ReSViNET for nurses and residents was R = 0.836 (p<0.001) and R = 0.815 (p<0.001). The area under the Receiver Operator Curve (aROC) for admission to PICU or HDU was 0.956 (CI: 0.92–0.99, p<0.001) and 0.880 (CI: 0.80–0.96, p<0.001) for nurse completed LIBSS and ReSViNET respectively. <h4>Conclusion</h4> LIBSS and ReSViNET were designed for infants with bronchiolitis in resource-rich settings. Both LIBSS and ReSViNET demonstrated good reliability and validity results, in this cohort of patients presenting to tertiary level hospitals. This early data demonstrate that these two scores have the potential to be used in conjunction with clinical reasoning to identify infants at increased risk of clinical deterioration and allow timely admission, treatment escalation and therefore support resource allocation in Rwanda.Boniface HakizimanaEdgar KalimbaAugustin NdatinyaGemma SaintClare van MiertPeter Thomas CartledgePublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 11 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Boniface Hakizimana Edgar Kalimba Augustin Ndatinya Gemma Saint Clare van Miert Peter Thomas Cartledge Field testing two existing, standardized respiratory severity scores (LIBSS and ReSViNET) in infants presenting with acute respiratory illness to tertiary hospitals in Rwanda – a validation and inter-rater reliability study
description	<h4>Introduction</h4> There is a substantial burden of respiratory disease in infants in the sub-Saharan Africa region. Many health care providers (HCPs) that initially receive infants with respiratory distress may not be adequately skilled to differentiate between mild, moderate and severe respiratory symptoms, which may contribute to poor management and outcome. Therefore, respiratory severity scores have the potential to contributing to address this gap. <h4>Objectives</h4> to field-test the use of two existing standardized bronchiolitis severity scores (LIBSS and ReSViNET) in a population of Rwandan infants (1–12 months) presenting with respiratory illnesses to urban, tertiary, pediatric hospitals and to assess the severity of respiratory distress in these infants and the treatments used. <h4>Methods</h4> A cross-sectional, validation study, was conducted in four tertiary hospitals in Rwanda. Infants presenting with difficulty in breathing were included. The LIBSS and ReSViNET scores were independently employed by nurses and residents to assess the severity of disease in each infant. <h4>Results</h4> 100 infants were recruited with a mean age of seven months. Infants presented with pneumonia (n = 51), bronchiolitis (n = 36) and other infectious respiratory illnesses (n = 13). Thirty-three infants had severe disease and survival was 94% using nurse applied LIBSS. Regarding inter-rater reliability, the intra-class correlation coefficient (ICC) for LIBSS and ReSViNET between nurses and residents was 0.985 (95% CI: 0.98–0.99) and 0.980 (0.97–0.99). The convergent validity (Pearson’s correlation) between LIBSS and ReSViNET for nurses and residents was R = 0.836 (p<0.001) and R = 0.815 (p<0.001). The area under the Receiver Operator Curve (aROC) for admission to PICU or HDU was 0.956 (CI: 0.92–0.99, p<0.001) and 0.880 (CI: 0.80–0.96, p<0.001) for nurse completed LIBSS and ReSViNET respectively. <h4>Conclusion</h4> LIBSS and ReSViNET were designed for infants with bronchiolitis in resource-rich settings. Both LIBSS and ReSViNET demonstrated good reliability and validity results, in this cohort of patients presenting to tertiary level hospitals. This early data demonstrate that these two scores have the potential to be used in conjunction with clinical reasoning to identify infants at increased risk of clinical deterioration and allow timely admission, treatment escalation and therefore support resource allocation in Rwanda.
format	article
author	Boniface Hakizimana Edgar Kalimba Augustin Ndatinya Gemma Saint Clare van Miert Peter Thomas Cartledge
author_facet	Boniface Hakizimana Edgar Kalimba Augustin Ndatinya Gemma Saint Clare van Miert Peter Thomas Cartledge
author_sort	Boniface Hakizimana
title	Field testing two existing, standardized respiratory severity scores (LIBSS and ReSViNET) in infants presenting with acute respiratory illness to tertiary hospitals in Rwanda – a validation and inter-rater reliability study
title_short	Field testing two existing, standardized respiratory severity scores (LIBSS and ReSViNET) in infants presenting with acute respiratory illness to tertiary hospitals in Rwanda – a validation and inter-rater reliability study
title_full	Field testing two existing, standardized respiratory severity scores (LIBSS and ReSViNET) in infants presenting with acute respiratory illness to tertiary hospitals in Rwanda – a validation and inter-rater reliability study
title_fullStr	Field testing two existing, standardized respiratory severity scores (LIBSS and ReSViNET) in infants presenting with acute respiratory illness to tertiary hospitals in Rwanda – a validation and inter-rater reliability study
title_full_unstemmed	Field testing two existing, standardized respiratory severity scores (LIBSS and ReSViNET) in infants presenting with acute respiratory illness to tertiary hospitals in Rwanda – a validation and inter-rater reliability study
title_sort	field testing two existing, standardized respiratory severity scores (libss and resvinet) in infants presenting with acute respiratory illness to tertiary hospitals in rwanda – a validation and inter-rater reliability study
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/3fbc7f834c2243acab265a96569c8752
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Field testing two existing, standardized respiratory severity scores (LIBSS and ReSViNET) in infants presenting with acute respiratory illness to tertiary hospitals in Rwanda – a validation and inter-rater reliability study

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