Pediatric Difficult Intravenous Access Scores in a Low-Resource Setting: An External Validation Study

Area of Science:

• Pediatric Emergency Medicine
• Vascular Access
• Global Health

Background:

• Difficult intravenous access (DIVA) poses challenges in pediatric emergency care, particularly in low- to middle-income countries (LMIC).
• Existing DIVA scores require validation and potential modification for diverse healthcare settings.

Purpose of the Study:

• To validate pediatric difficult intravenous access (DIVA) scores in LMIC emergency settings.
• To identify factors associated with DIVA for developing an optimized score.

Main Methods:

• Prospective cross-sectional study of 392 children (0-15 years) requiring peripheral intravenous access (PIVA).
• DIVA defined as first-attempt PIVA failure.
• Analysis included ROC curves, logistic regression for predictive factors, and development of the LMIC-DIVA score.

Main Results:

• The difficult intravenous access (DIVA) rate was 30.1%.
• Factors associated with DIVA included vein visibility, vein palpability, younger age, and prior DIVA history.
• The novel LMIC-DIVA score showed superior discriminative ability (AUC 0.79) compared to DIVA3 (AUC 0.65) and DIVA4 (AUC 0.62).

Conclusions:

• The study provides external validation for DIVA3 and DIVA4 in an LMIC context.
• The modified 4-variable LMIC-DIVA score demonstrates improved accuracy for identifying pediatric difficult intravenous access.
• This enhanced score can optimize emergency care in resource-limited settings.