title: Validating the difficult intravenous access clinical prediction rule.
abstract: OBJECTIVE
  This study aimed to evaluate the difficult intravenous access (DIVA) score, a clinical prediction rule, which states that children with a score of 4 or more will have a 50% higher rate of a failed intravenous placement on the first attempt compared with the mean failure rate.
  
  
  METHODS
  This was a prospective cohort study in children 0 to 14 years, undergoing peripheral intravenous placement by doctors in the emergency department of a medium-sized general hospital. Before intravenous placement attempts, demographic data inclusive of age and DIVA score were recorded. A maximum of 3 attempts per doctor were allowed, after which a more senior doctor undertook subsequent attempts. The site of successful placement was recorded.
  
  
  RESULTS
  Five hundred children were enrolled. The male-female ratio was 1.3:1. One hundred thirty-three (26.6%) were less than 1 year, 103 (20.6%) were aged 1 to 2 years, and 264 (52.8%) were 3 years or older. One hundred ten children (22%) had a failed intravenous placement on the first attempt. Of the 151 children with a DIVA score of 4 or more, 57 (37.7%) had a failed intravenous placement, validating the clinical prediction rule. Only 5 subjects (1%) did not have intravenous placement after 6 attempts.
  
  
  CONCLUSIONS
  This study validates DIVA score and provides a simple tool that can enhance the accuracy of the information offered to parents as it relates to the success rates of intravenous placement in children.
authors.affiliation: Department of Paediatrics, Mayo General Hospital, Castlebar, Ireland. drmichaeloneill@gmail.com
authors.forename: Michael Brendan
authors.initials: MB
authors.lastname: O'Neill
authors.forename: Martina
authors.initials: M
authors.lastname: Dillane
authors.forename: Noor Fahitah Abu
authors.initials: NF
authors.lastname: Hanipah
mesh_terms: D061605:Administration, Intravenous / Q000379:methods / Q000706:statistics & numerical data; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003661:Decision Support Techniques; D004636:Emergency Service, Hospital; D005260:Female; D005865:Gestational Age; D006769:Hospitals, General; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D010173:Palpation; D010290:Parents / Q000523:psychology; D011446:Prospective Studies; D014680:Veins / Q000033:anatomy & histology