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Field testing two existing, standardized respiratory severity scores (LIBSS and ReSViNET) in infants presenting with
Boniface Hakizimana1,2, Edgar Kalimba1,3, Augustin Ndatinya4
1Department of Pediatrics, School of Medicine, University of Rwanda, Kigali, Rwanda.
Insights
Two respiratory severity scores, LIBSS and ReSViNET, showed good reliability and validity in Rwandan infants. These tools can help identify infants at risk of deterioration, improving management and resource allocation in sub-Saharan Africa.
Area of Science:
- Pediatric respiratory medicine
- Global health
Background:
- Sub-Saharan Africa faces a significant burden of infant respiratory disease.
- Healthcare providers often lack skills to differentiate respiratory symptom severity, impacting infant outcomes.
- Standardized respiratory severity scores can help address this management gap.
Purpose of the Study:
- To field-test the Likelihood to be Admitted to the Pediatric Intensive Care Unit Score (LIBSS) and the Respiratory Syncytial Virus in Neonates and Infants (ReSViNET) scores in Rwandan infants.
- To assess the severity of respiratory distress and treatments used in infants presenting to tertiary pediatric hospitals in Rwanda.
Main Methods:
- A cross-sectional validation study was conducted in four Rwandan tertiary hospitals.
- Infants (1-12 months) presenting with respiratory distress were included.
- Nurses and residents independently used LIBSS and ReSViNET to assess disease severity.
Main Results:
- 100 infants were recruited; 51 had pneumonia, 36 bronchiolitis. 94% survival was observed with nurse-applied LIBSS.
- LIBSS and ReSViNET demonstrated high inter-rater reliability (ICC > 0.98) and convergent validity (R > 0.81).
- Area under the curve for predicting PICU/HDU admission was high for both scores (LIBSS: 0.956, ReSViNET: 0.880).
Conclusions:
- LIBSS and ReSViNET showed good reliability and validity in Rwandan infants presenting to tertiary hospitals.
- These scores can aid in identifying infants at risk of clinical deterioration.
- Potential to support timely interventions and resource allocation in Rwanda.
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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