Table 2.
Principal findings of instruments selected as the best available ones, based on what the instruments measures and how well they have been validated
| Instrument | References of studies that used the instrument | Measured characteristics | Scoring | Where the instrument’s items originated | Assessment of the items for | Reliability | Validity | Usability | Key points that make the instrument outstanding |
|---|---|---|---|---|---|---|---|---|---|
| Wood Downes’s modified by Ferres score (WDF). (Flores-Gonzalez JC) [9]. | [9, 34] |
|
Score (0–14), with higher scores indicating more severe disease. | Previous score |
|
Not assessed | Construct validity: The WDF scores in patients who required subsequent admission to the PICUa were significantly higher than those inpatients who required admission only to the PMFb (6(4–8) vs 5(4–8), p=0.026).[9] Patients with scores of the WDF between 4 and 7 had a significant lower LOS compared to patients with scores >7 (4.8 vs. 13.44 days, p<0.0001).[34] | Not assessed | Adequate construct validity and responsiveness |
| The respiratory score. (Gajdos V. et al) [6]. | [6] |
|
Score (1–9) where higher scores indicate more severe disease | The score included parameters of respiratory status easily assessable in children of all ages, particularly in young children, at discretion of authors. |
|
Inter-rater agreement. For all provider pairs: 93.1%, with a Kw: 0.72 (95% CI, 0.66–0.78). For the various age groups ranged from 87% to 93%, with KWc ranging from 0.62 to 0.78.[6] | Not assessed | Not assessed | Inclusion of simple and well-categorized items readily available even in resource-limited settings), and suitable by all healthcare provider s (except wheezing). Adequate inter-rater agreement |
|
| |||||||||
| A respiratory clinical score. (Liu LL. et al) [7]. | [7] |
|
Score (0–12) with higher scores indicating greater severity of bronchiolitis | Items selected for use in the score were derived from a literature review of clinical scores, and were common signs of respiratory status that were easily measured in children of all ages, particularly young children. |
|
Inter-rater agreement. rater pairs had high observed agreement on total score of 82–88% and Kw ranging from 0.52 (95% CI: 0.19–0.79) to 0.65 (95% CI: 0.46–087).[7] | Not assessed | Not assessed | Inclusion of simple and well-categorized items readily available even in resource-limited settings), and suitable by all healthcare providers (except wheezing). Adequate inter-rater agreement |
|
| |||||||||
| Bronchiolitis risk of admission score. (Marlais, M. et al.) [15]. | [15] |
|
Score (0–5) with higher scores indicating greater severity of bronchiolitis | Clinical predictors of admission were determined through case note review and logistic regression analysis. The strongest predictors of admission were assimilated into a simple clinical risk scoring system using widely accepted statistical methods. | Construct validity: The aROCd for the final clinical risk score was 0.81 (95% CI 0.77 to 0.85). The optimal cut-off using this score was found to be a score of ≥3 requiring admission. At this cutoff the sensitivity was 74% and specificity was 77%. The PPVe was 67% and the NPVf 83%.[15] | Inclusion of simple and well-categorized items readily available even in resource-limited settings (except oxygen saturation), and suitable by all healthcare providers, including nonphysician providers. Items were derived from an evidence-based literature review and used a formal procedure for their selection. Adequate construct validity | |||
|
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| Respiratory severity scoring (RSS-HR). (Rodriguez H. et al) [16]. | [16, 68] |
|
Score (0–12), with higher scores indicating more severe disease. | Previous score |
|
Inter-rater agreement, a perfect agreement was found between observers in the wheezing and accessory muscle scores in six of eight patients. In two patients these scores differed by one point between observers.[68] | Construct validity: The RSS-HR median score was higher in infants that were hospitalize d vs. outpatient (8.0 vs. 4.0, p < 0.001).[16] | Not assessed | Inclusion of simple and well-categorized items readily available even in resource- limited settings), and suitable by all healthcare providers (except wheezing). Adequate construct validity and inter-rater agreement. |
|
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| The modified Wood’s Clinical Asthma Score (M-WCAS). (Wood DW. et al) [17]. | [8, 82] |
|
Score (0–10), with higher scores indicating greater severity of bronchiolitis. The M-WCAS includes “mild” categories of 0.5 points to better define the clinical response to therapy | Previous instrument |
|
Inter-rater agreement. Kw: 0.897 (p<0.001), 95% CI (0.699–1.000).[8] Kw: 0.831.[82] | Criterion validity: The scores of the M-WCAS correlated positively with the scores of the Tal score (r=.0.761, p<0.001).[8] Construct validity: The scores of the M-WCAS in patients who required subsequent admission to the PICU were significantly higher than those inpatients who required admission only to the PMF [4.5 (3.6–5.2) vs. 2.5(1.5–2.5), p<0.001].[8] | All raters qualified the M-WCAS as easy to score, and they reported that the time required to complete the score ranged from 1 to 3 min.[8] | Adequate construct validity, criterion validity, inter-rater agreement, responsiveness, and usability |
PICU: pediatric intensive care unit
PMF: pediatric medical floor
Kw: weighted kappa
aROC: area under the ROC curve
PPV: positive predictive value
NPV: negative predictive value