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Cross-cultural adaptation and validation of the pediatric difficult intravenous access (DIVA) prediction score in
María de la Vieja-Soriano1, Ignacio Zaragoza-García2, Alberto Galindo-Muñoz3
1Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario 12 de Octubre, Madrid, Spain.
Introduction:
The percentage of difficult intravenous access cases is high in pediatric care, and multiple attempts may be needed to establish peripheral venous access. The DIVA score allows identification of these patients; however, a validated version of this tool is not yet available in Spain. The objective of this study was to develop the Spanish version of the DIVA score.
Material And Methods:
We conducted a cross-sectional descriptive study with psychometric analysis in two phases: adaptation of the DIVA score to Spanish and analysis of the psychometric properties of the Spanish version (DIVA-SP). The first phase consisted in the forward and back translation and back-translation of the score followed by expert evaluation and pretesting to develop the DIVA-SP. In the second phase, the scale was validated in a sample of patients aged up to 16 years admitted to different departments of a tertiary care hospital who required peripheral venous access. The nurse in charge of the patient completed the scale, which was included in an ad-hoc questionnaire along with other items to collect sociodemographic data.
Results:
A total of 353 catheterizations were included. All items exhibited reliability with kappa values greater than 0.61. In the analysis of robustness, all items were deemed adequate except the history of prematurity. For the three-variable model, a cut-off point of 4 in the DIVA score showed a sensitivity of 0.45, a specificity of 0.81, a positive predictive value of 0.64, a negative predictive value of 0.67, a positive likelihood ratio of 2.44 and a negative likelihood ratio of 0.67. Of all patients, 66% were classified correctly and 33% incorrectly.
Conclusions:
The DIVA-SP is useful, valid and reliable for application in Spain. Furthermore, it exhibits better psychometric properties than the original version for identifying difficult intravenous access in pediatric patients.
