Modified DIVA Score: An Improved Clinical Predictive Tool for Detecting Difficult Access in Children.

Area of Science:

• Pediatric Emergency Medicine
• Vascular Access
• Clinical Assessment Tools

Background:

• Difficult intravenous (IV) access is a common challenge in pediatric emergency care.
• The Difficult Intravenous Access (DIVA) score aims to predict and identify patients with challenging IV access needs.
• Validation of existing tools and exploration of new predictors are crucial for optimizing patient care.

Purpose of the Study:

• To validate the DIVA score in a pediatric population.
• To identify additional patient characteristics associated with difficult IV access in children.
• To develop an improved tool for predicting difficult IV access.

Main Methods:

• A cross-sectional study of 300 pediatric patients (age < 21) in a quaternary pediatric emergency department.
• Data collected included DIVA score components, history of difficult access, hydration status, skin shade, comorbidities, and technology dependence.
• Difficult access was defined as ≥2 attempts or >30 minutes for IV cannulation.

Main Results:

• The original DIVA score showed 51% sensitivity and 83% specificity for difficult IV access.
• "History of difficult access" was the only additional characteristic that improved prediction (61% sensitivity, 76% specificity).
• The modified DIVA (m-DIVA) score, including "history of difficult access," demonstrated 78% sensitivity and 67% specificity, a 52.9% improvement in correct identification.

Conclusions:

• The m-DIVA score, by incorporating prior IV access history, enhances the sensitivity of screening for difficult IV access in pediatric patients.
• The m-DIVA score shows promise as a valuable clinical tool for improving the prediction of difficult IV access.
• Further investigation and validation of the m-DIVA score in clinical practice are warranted.