title: Validity of respiratory scores in bronchiolitis.
abstract: OBJECTIVE
  The primary objective of this study was to establish the validity and reliability of 2 respiratory scores, the Respiratory Distress Assessment Instrument (RDAI) and the Children's Hospital of Wisconsin Respiratory Score (CHWRS), in bronchiolitis. A secondary objective was to identify the respiratory score components that most determine overall respiratory status.
  
  
  METHODS
  This was a prospective cohort study in infants aged < 1 year seen at Children's Hospital of Wisconsin for bronchiolitis. We evaluated: (1) discriminative validity (the score's ability to discriminate between 2 different outcomes) of the respiratory scores to identify emergency department (ED) disposition by using receiver operating characteristic curves; and (2) construct validity (the score's ability to measure what it is thought to measure, overall respiratory status) by using length of stay (LOS) as a proxy for disease severity and comparing correlations between changes in respiratory scores and LOS. Interrater reliability was established by using intraclass correlation. The contribution of individual respiratory score components to determine ED disposition was studied by using multivariate logistic regression.
  
  
  RESULTS
  A total of 195 infants were included. The area under the receiver operating characteristic curve was 0.68 for CHWRS versus 0.51 for RDAI in predicting disposition. There was no correlation between initial respiratory scores or change in respiratory scores over the first 24 hours and LOS. Item analysis revealed that oxygen delivery, subcostal retractions, and respiratory rate were independently correlated with ED disposition. The CHWRS was more reliable than the RDAI.
  
  
  CONCLUSIONS
  The CHWRS had modest discriminative validity in predicting ED disposition. Neither the CHWRS nor the RDAI had good construct validity. Respiratory rate, oxygen need, and presence of retractions were most useful in predicting ED disposition.
authors: Department of Pediatrics, Stanford University, Palo Alto, California, USA.
authors: Lauren
authors: L
authors: Destino
authors: Michael C
authors: MC
authors: Weisgerber
authors: Paula
authors: P
authors: Soung
authors: Deborah
authors: D
authors: Bakalarski
authors: Ke
authors: K
authors: Yan
authors: Rebecca
authors: R
authors: Rehborg
authors: Duke R
authors: DR
authors: Wagner
authors: Marc H
authors: MH
authors: Gorelick
authors: Pippa
authors: P
authors: Simpson
mesh_terms: D001988:Bronchiolitis / Q000175:diagnosis*; D006305:Health Status Indicators; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007902:Length of Stay; D016015:Logistic Models; D015999:Multivariate Analysis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D018570:Risk Assessment