Can a Respiratory Severity Score Accurately Assess Respiratory Distress in Children with Bronchiolitis in a Resource-Limited Setting?

Hakizimana, Boniface; Saint, Gemma; Miert, Clare van; Cartledge, Peter

doi:10.1093/tropej/fmz055

Cited by 8 publications

(18 citation statements)

References 31 publications

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“…As there is no "gold standard" for determining the severity of respiratory distress, clinical severity was defined by outpatient management (mild), admission (moderate) and severe (HDU/PICI admission). We determined the severity of illness using the LIBSS and ReSViNET pre-defined cut-points of Mild (0-10); Moderate (11)(12)(13)(14)(15)(16)(17)(18)(19)(20); Severe (>21) for LIBSS [28] and 0-6 for mild affection, 7-13 for moderate distress, and 14-20 using ReSVi-NET [25,43].…”

Section: Severity Of Diseasementioning

confidence: 99%

“…Instruments could be used by HCPs in their decision making, such as when to admit children, or when to escalate care of infants with respiratory distress. In order to be fit for purpose, such an instrument should be validated, reliable, quick to perform, and straightforward to interpret in the clinical context [ 15 ]. It should not involve complex measurements, descriptions or equipment.…”

Section: Introductionmentioning

confidence: 99%

“…Both the LIBSS and ReSViNET instruments share five parameters and employ clinical parameters assessed by HCPs [ 15 ]. The parameters of both scores are applicable to all respiratory diseases that can cause respiratory distress in infants in settings such as Rwanda, and can be undertaken with no equipment (ReSViNET) or with just a saturation monitor (LIBSS).…”

Section: Introductionmentioning

confidence: 99%

“…One such model is a clinical measurement instrument consisting of clinical signs and symptoms that are grouped together to measure an intended construct. The validation of such an instrument should ideally include: assessment of reliability, responsiveness, and usability [9][10][11][12][13][14][15]. Instruments could be used by HCPs in their decision making, such as when to admit children, or when to escalate care of infants with respiratory distress.…”

Section: Introductionmentioning

confidence: 99%

“…There are several respiratory distress instruments from high-income countries (HIC), with many being developed specifically for single pathologies such as bronchiolitis [9,[15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33]. Several models have been developed in resource-limited settings, to assess for primary outcomes of mortality or antibiotic-treatment failure in children with severe bacterial pneumonia, namely; The Mamtani score from India, modified Respiratory Index of Severity in Children (RISC) from Kenya, RISC-Malawi and the original RISC Score from South Africa [15,[34][35][36][37][38]. However, the income and health provisions in these countries are broad, varying between lowincome (LIC) Malawi, and upper-middle income (UMIC) South Africa.…”

Section: Introductionmentioning

confidence: 99%

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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

et al. 2021

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Introduction 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. Objectives 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. Methods 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. Results 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. Conclusion 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.

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