title: Evaluating the test re-test reliability and inter-subject variability of Health Care Provider manual fluid resuscitation performance.
abstract: BACKGROUND
  Health Care Providers (HCPs) report that manual techniques of intravascular fluid resuscitation are commonly used during pediatric shock management. The optimal pediatric fluid resuscitation technique is currently unknown. We sought to determine HCP test-retest reliability (repeatability) and inter-subject variability of fluid resuscitation performance outcomes to inform the design of future studies.
  
  
  METHODS
  Fifteen consenting HCPs from McMaster Children's Hospital, in Hamilton, Canada participated in this single-arm interventional trial. Participants were oriented to a non-clinical model representing a 15 kg toddler, which incorporated a 22-gauge IV catheter. Following a standardization procedure, participants administered 600 mL (40 mL/kg) of saline to the simulated child under emergency conditions using prefilled 60-mL syringes. Each participant completed 5 testing trials. All testing was video recorded, with fluid administration time outcome data (in seconds) extracted from trial videos by two blinded outcome assessors. Data describing catheter dislodgement events, volume of saline effectively delivered, and participant demographics were also collected. The primary outcome of fluid administration time test-retest reliability was analyzed by one-way analysis of variance (ANOVA) and intra-class correlation (ICC), with good reliability defined as ICC > 0.70.
  
  
  RESULTS
  Differences in HCP fluid administration times are attributable to inter-subject variability rather than intra-subject variability based on one-way ANOVA analysis, F (14,60) = 43.125; p < 0.001. Test-retest reliability of subjects was excellent with ICC = 0.97 (95% CI: 0.95-0.99); p < 0.001.
  
  
  CONCLUSIONS
  Findings demonstrate excellent test-retest reliability of HCP fluid resuscitation performance in a setting involving a non-clinical model. Investigators can justify a single evaluation of HCP performance in future studies.
authors.affiliation: Department of Pediatrics, McMaster Children's Hospital and McMaster University, 1280 Main St W, Room 3A, Hamilton, Ontario L8S 4K1, Canada. parkermj@mcmaster.ca.
authors.forename: Melissa J
authors.initials: MJ
authors.lastname: Parker
authors.forename: Frank M H
authors.initials: FM
authors.lastname: Lee
authors.forename: Lawrence
authors.initials: L
authors.lastname: Mbuagbaw
authors.forename: Lehana
authors.initials: L
authors.lastname: Thabane
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D002675:Child, Preschool; D002983:Clinical Competence / Q000592:standards; D005260:Female; D005440:Fluid Therapy / Q000009:adverse effects / Q000592:standards*; D019983:Guideline Adherence / Q000592:standards; D006282:Health Personnel / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D007223:Infant; D007262:Infusions, Intravenous; D008297:Male; D008348:Manikins; D008505:Medical Staff, Hospital / Q000592:standards; D008875:Middle Aged; D009741:Nursing Staff, Hospital / Q000592:standards; D009864:Ontario; D010043:Outcome and Process Assessment, Health Care / Q000592:standards*; D017410:Practice Guidelines as Topic / Q000592:standards; D010818:Practice Patterns, Physicians' / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000592:standards*; D015203:Reproducibility of Results; D012151:Resuscitation / Q000009:adverse effects / Q000379:methods / Q000592:standards*; D016037:Single-Blind Method; D012965:Sodium Chloride / Q000008:administration & dosage* / Q000009:adverse effects; D013337:Students, Medical; D013647:Task Performance and Analysis; D016896:Treatment Outcome; D014741:Video Recording; D055815:Young Adult
chemical_list: D012965:Sodium Chloride