Comparison of Kristjansson Respiratory Score and Wang Respiratory Score in infants with bronchiolitis in a hospital emergency department

Abstract

Objectives:Several respiratory scores have been created to evaluate bronchiolitis’ severity level, but it is still not clear which is the best score. The aim of this study is to compare the Wang Respiratory Score (WRS) and the Kristjansson Respiratory Score (KRS) in the setting of an emergency room. Methods:We performed a prospective observational study with 60 infants with bronchiolitis admitted to a paediatric emergency department. For both scores, we assessed inter-rater reliability between two different health professionals (physician and physiotherapist), internal consistency, and correlation with SpO2 testing the intraclass-correlation coefficient (ICC), weighted kappa, Cronbach [Formula: see text] coefficient and Spearman tests, respectively. Results:The inter-rater reliability was higher in KRS (ICC 0.79) and the Cronbach [Formula: see text] and weighted kappa had similar values in KRS versus WRS. The correlation between the KRS/WRS and SpO2 was poor/moderate upon admission and discharge for the first observer and the second observer. Conclusions:While the internal consistency was similar in both scores, inter-rater reliability of KRS was higher than WRS, which allows us to conclude that it would have more consistent results when used to assess bronchiolitis’ level of severity by health personnel in a busy hospital emergency room.

Ambulatory chest physiotherapy in mild-to-moderate acute bronchiolitis in children under two years of age — A randomized control trial

“…All children were observed in a quiet environment, while awake and not crying, and were submitted to a standard protocol consisting of clinical demographic data collection and assessment of oxygen saturation using pulse oximetry and of the Kristjansson Respiratory Score (KRS) to quantify the severity of the respiratory status of the child. 16 , 17 , 18 Although Wang Respiratory Score (WRS) is a more widely used score, studies comparing it with KRS show that this has better interobserver reliability, a very important aspect to this study. 17 , 18 This assessment was attributed to each child, at PED admission, at PED discharge and at day 7 and day 15.…”

“… 16 , 17 , 18 Although Wang Respiratory Score (WRS) is a more widely used score, studies comparing it with KRS show that this has better interobserver reliability, a very important aspect to this study. 17 , 18 This assessment was attributed to each child, at PED admission, at PED discharge and at day 7 and day 15.…”

“…Each clinical sign is scored from zero to two and the total score ranges from 0 to 10, with the severity being established as the total score increases (Table 1 ). 16 , 17 , 18 …”

Comparison of hypertonic-saline vs normal-saline nebulization in children with bronchiolitis.

“…After randomization each patient was assessed for respiratory rate, wheezing, retraction, and general condition to calculate clinical severity score (CSS) as described by Wang et al, at time of presentation and after 24 hours of management according to their assigned group. 12 Second assessment for CSS was done to evaluate response in term of change in CSS, that was calculated by subtracting the CSS after 24 hours from CSS at the time of presentation, as per operational definition.…”

Chest physiotherapy for children with acute bronchiolitis: Do we need more evidence?

“…Even though the inter-rater reliability of the respiratory score employed was previously established by the same authors, it is obvious that the assessment of the clinical severity was highly subjective and performed by different investigators that were fully aware of each children’s allocation. 2 Consciously or not, the physiotherapist rating the clinical severity of the children from the control group was likely to overrate it for children he knew were not assigned to any CP intervention. The positive effects for the CP intervention could thereby have been artificially created by these measurement errors.…”