Development and Validation of a New Clinical Scale for Infants with Acute Respiratory Infection: The ReSVinet Scale

Background and Aims A properly validated scoring system allowing objective categorization of infants with acute respiratory infections (ARIs), avoiding the need for in-person assessment and that could also be used by non-health professionals is currently not available. We aimed to develop a new clinical assessment scale meeting these specifications. Methods We designed a clinical scale (ReSVinet scale) based on seven parameters (feeding intolerance, medical intervention, respiratory difficulty, respiratory frequency, apnoea, general condition, fever) that were assigned different values (from 0 to 3) for a total of 20 points.170 children under two years of age with ARI were assessed independently by three pediatricians using this scale. Parents also evaluated their offspring with an adapted version of the scale in a subset of 61 cases. The scale was tested for internal consistency (Cronbach’s alpha), Pearson correlation coefficient for the items in the scale, inter-observer reliability (kappa index) and floor-ceiling effect. Results Internal consistency was good for all the observers, with the lowest Cronbach’s alpha being 0.72. There was a strong correlation between the investigators (r-value ranged 0.76–0.83) and also between the results obtained by the parents and the investigators(r = 0.73). Light’s kappa for the observations of the three investigators was 0.74. Weighted kappa in the group evaluated by the parents was 0.73. The final score was correlated with length of hospital stay, PICU admission and Wood-Downes Score. Conclusions The ReSVinet scale may be useful and reliable in the evaluation of infants with ARI, particularly acute bronchiolitis, even with data obtained from medical records and when employed by parents. Although further studies are necessary, ReSVinet scale already complies with more score validation criteria than the vast majority of the alternatives currently available and used in the clinical practiceThis work was supported by the Spanish Government (Research Program Health Research Fund – [http://www.gendres.org] (FIS; PI10/00540 y PI13/02382) National Plan I + D + I and FEDER funds) and Regional Galician funds (Promotion of Research Project 10 PXIB 918 184 PR) (FMT), and Ministerio de Ciencia e Innovación (SAF2011-26983) and the Plan Galego IDT, Xunta de Galicia (EM 2012/045) (AS). MC’s research activities have been supported by grants from Instituto de Investigación Sanitaria de Santiago de Compostela. FMT’s research activities have been supported by grants from Instituto Carlos III (Intensificación de la actividad investigadora- ISCIII/INT14/00245/ Cofinanciado FEDER), Spanish National Plan I + D + i and FEDER funds. Investigators received funding from the European Union’s Seventh Framework Program under ECGA no. 279185 (EUCLIDS – [http://www.euclids-project.eu]) during the production of this paper. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscriptS

Development and Validation of a New Clinical Scale for Infants with Acute Respiratory Infection: The ReSVinet Scale - Fig 1

<p>Comparison of results obtained (A) by the three observers, and (B) by the parents and one of the observers. <u>In graph A:</u> O1- Results obtained by observer 1. O2- Results obtained by observer 2. O3- Results obtained by observer 3. <u>In graph B:</u> O1- Results obtained by observer 1. P—Results obtained by the parents.</p

Check-list of the characteristics of the ReSVinet scale according to the desired properties of a clinical scale validated for use in infants with acute respiratory infections^*.

<p>The “considerations” column explains whether the ReSVinet scale meets the requirement. N.A. = not assessed.</p

Results of the ReSVinet scale in the professional cohort (Group 1).

<p>This table categorizes patients according to clinical, epidemiological and outcome variables in the cohort evaluated by three pediatricians.</p

Results of the ReSVinet scale in the parental cohort (group 2).

<p>This table reflects the results of the score obtained by a physician (observer 1) and parents and the relation of the values obtained with clinical, epidemiological and outcome variables.</p

ReSVinet scale.

<p>This table presents the original scale, and was the one used by the three investigators.</p