Severity scoring systems

Are they internally valid, reliable and predictive of oxygen use in children with acute bronchiolitis?

Gabrielle Mccallum, Peter Morris, Clare McKay, Lesley Versteegh, Linda Ward, Mark Chatfield, Anne Chang

    Research output: Contribution to journalArticleResearchpeer-review

    Abstract

    Background: Severity scores are commonly used in research and clinically to assess the severity of bronchiolitis. However, there are limitations as few have been validated. The aim of our study was to: (i) determine the validity and reliability of a bronchiolitis scoring system, and (ii) examine if the score predicted the need for oxygen at 12 and 24 hrs. Children aged <24 months presenting to Royal Darwin Hospital with a clinical diagnosis of bronchiolitis were eligible to participate.

    Study Design: We reviewed published papers that used a bronchiolitis score and summarized the data in a table. We chose the Tal score that was easy to use and encompassed clinically important parameters. Three research nurses, trained to assess children, used two scoring systems (Tal and Modified-Tal; respiratory rate, accessory muscle use, wheezing, cyanosis, and oxygen saturation), blindly evaluated children within 15 min of each other.

    Results: The children's (n = 115) median age was 5.4 months (IQR 2.9, 10.4); 65% were male and 64% were Indigenous. Internal consistency was excellent (Tal: Cronbach α = 0.66; Modified-Tal: α = 0.70). There was substantial inter-rater agreement; weighted kappa of 0.72 (95% CI: 0.63, 0.83) for Tal and 0.70 (95% CI: 0.63, 0.76) for Modified-Tal. For predicting requirement for oxygen at 12 and 24 hrs; area under receiver operating curve (aROC) was 0.69 (95% CI: 0.13, 1.0) and 0.75 (95% CI: 0.34, 1.0), respectively.

    Conclusion: The Tal and Modified-Tal scoring systems for bronchiolitis is repeatable and can reliably be used in research and clinical practice. Its utility for prediction of O2 requirement is limited. 

    Original languageEnglish
    Pages (from-to)797-803
    Number of pages7
    JournalPediatric Pulmonology
    Volume48
    Issue number8
    Early online dateSep 2012
    DOIs
    Publication statusPublished - Aug 2013

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    Bronchiolitis
    Oxygen
    Cyanosis
    Respiratory Sounds
    Respiratory Rate
    Research
    Reproducibility of Results
    Nurses
    Muscles

    Cite this

    @article{9d41f277aaf449389dac916b69a7f893,
    title = "Severity scoring systems: Are they internally valid, reliable and predictive of oxygen use in children with acute bronchiolitis?",
    abstract = "Background: Severity scores are commonly used in research and clinically to assess the severity of bronchiolitis. However, there are limitations as few have been validated. The aim of our study was to: (i) determine the validity and reliability of a bronchiolitis scoring system, and (ii) examine if the score predicted the need for oxygen at 12 and 24 hrs. Children aged <24 months presenting to Royal Darwin Hospital with a clinical diagnosis of bronchiolitis were eligible to participate. Study Design: We reviewed published papers that used a bronchiolitis score and summarized the data in a table. We chose the Tal score that was easy to use and encompassed clinically important parameters. Three research nurses, trained to assess children, used two scoring systems (Tal and Modified-Tal; respiratory rate, accessory muscle use, wheezing, cyanosis, and oxygen saturation), blindly evaluated children within 15 min of each other. Results: The children's (n = 115) median age was 5.4 months (IQR 2.9, 10.4); 65{\%} were male and 64{\%} were Indigenous. Internal consistency was excellent (Tal: Cronbach α = 0.66; Modified-Tal: α = 0.70). There was substantial inter-rater agreement; weighted kappa of 0.72 (95{\%} CI: 0.63, 0.83) for Tal and 0.70 (95{\%} CI: 0.63, 0.76) for Modified-Tal. For predicting requirement for oxygen at 12 and 24 hrs; area under receiver operating curve (aROC) was 0.69 (95{\%} CI: 0.13, 1.0) and 0.75 (95{\%} CI: 0.34, 1.0), respectively. Conclusion: The Tal and Modified-Tal scoring systems for bronchiolitis is repeatable and can reliably be used in research and clinical practice. Its utility for prediction of O2 requirement is limited. ",
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    author = "Gabrielle Mccallum and Peter Morris and Clare McKay and Lesley Versteegh and Linda Ward and Mark Chatfield and Anne Chang",
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    Severity scoring systems : Are they internally valid, reliable and predictive of oxygen use in children with acute bronchiolitis? / Mccallum, Gabrielle; Morris, Peter; McKay, Clare ; Versteegh, Lesley; Ward, Linda; Chatfield, Mark; Chang, Anne.

    In: Pediatric Pulmonology, Vol. 48, No. 8, 08.2013, p. 797-803.

    Research output: Contribution to journalArticleResearchpeer-review

    TY - JOUR

    T1 - Severity scoring systems

    T2 - Are they internally valid, reliable and predictive of oxygen use in children with acute bronchiolitis?

    AU - Mccallum, Gabrielle

    AU - Morris, Peter

    AU - McKay, Clare

    AU - Versteegh, Lesley

    AU - Ward, Linda

    AU - Chatfield, Mark

    AU - Chang, Anne

    PY - 2013/8

    Y1 - 2013/8

    N2 - Background: Severity scores are commonly used in research and clinically to assess the severity of bronchiolitis. However, there are limitations as few have been validated. The aim of our study was to: (i) determine the validity and reliability of a bronchiolitis scoring system, and (ii) examine if the score predicted the need for oxygen at 12 and 24 hrs. Children aged <24 months presenting to Royal Darwin Hospital with a clinical diagnosis of bronchiolitis were eligible to participate. Study Design: We reviewed published papers that used a bronchiolitis score and summarized the data in a table. We chose the Tal score that was easy to use and encompassed clinically important parameters. Three research nurses, trained to assess children, used two scoring systems (Tal and Modified-Tal; respiratory rate, accessory muscle use, wheezing, cyanosis, and oxygen saturation), blindly evaluated children within 15 min of each other. Results: The children's (n = 115) median age was 5.4 months (IQR 2.9, 10.4); 65% were male and 64% were Indigenous. Internal consistency was excellent (Tal: Cronbach α = 0.66; Modified-Tal: α = 0.70). There was substantial inter-rater agreement; weighted kappa of 0.72 (95% CI: 0.63, 0.83) for Tal and 0.70 (95% CI: 0.63, 0.76) for Modified-Tal. For predicting requirement for oxygen at 12 and 24 hrs; area under receiver operating curve (aROC) was 0.69 (95% CI: 0.13, 1.0) and 0.75 (95% CI: 0.34, 1.0), respectively. Conclusion: The Tal and Modified-Tal scoring systems for bronchiolitis is repeatable and can reliably be used in research and clinical practice. Its utility for prediction of O2 requirement is limited. 

    AB - Background: Severity scores are commonly used in research and clinically to assess the severity of bronchiolitis. However, there are limitations as few have been validated. The aim of our study was to: (i) determine the validity and reliability of a bronchiolitis scoring system, and (ii) examine if the score predicted the need for oxygen at 12 and 24 hrs. Children aged <24 months presenting to Royal Darwin Hospital with a clinical diagnosis of bronchiolitis were eligible to participate. Study Design: We reviewed published papers that used a bronchiolitis score and summarized the data in a table. We chose the Tal score that was easy to use and encompassed clinically important parameters. Three research nurses, trained to assess children, used two scoring systems (Tal and Modified-Tal; respiratory rate, accessory muscle use, wheezing, cyanosis, and oxygen saturation), blindly evaluated children within 15 min of each other. Results: The children's (n = 115) median age was 5.4 months (IQR 2.9, 10.4); 65% were male and 64% were Indigenous. Internal consistency was excellent (Tal: Cronbach α = 0.66; Modified-Tal: α = 0.70). There was substantial inter-rater agreement; weighted kappa of 0.72 (95% CI: 0.63, 0.83) for Tal and 0.70 (95% CI: 0.63, 0.76) for Modified-Tal. For predicting requirement for oxygen at 12 and 24 hrs; area under receiver operating curve (aROC) was 0.69 (95% CI: 0.13, 1.0) and 0.75 (95% CI: 0.34, 1.0), respectively. Conclusion: The Tal and Modified-Tal scoring systems for bronchiolitis is repeatable and can reliably be used in research and clinical practice. Its utility for prediction of O2 requirement is limited. 

    KW - article

    KW - breathing rate

    KW - bronchiolitis

    KW - bronchiolitis scoring system

    KW - childhood disease

    KW - clinical practice

    KW - cohort analysis

    KW - cyanosis

    KW - disease severity

    KW - female

    KW - human

    KW - infant

    KW - major clinical study

    KW - male

    KW - nurse

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    KW - Humans

    KW - Infant

    KW - Male

    KW - Oxygen

    KW - Prognosis

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    KW - Reproducibility of Results

    KW - ROC Curve

    KW - Severity of Illness Index

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