Validity of respiratory scores in bronchiolitis.

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.

Perceptions about water and increased use of bottled water in minority children.

OBJECTIVE: To describe bottled water use and beliefs and attitudes about water among parents of children from different racial/ethnic groups. DESIGN: Cross-sectional survey. SETTING: Urban/suburban emergency department. PARTICIPANTS: Parents of children treated between September 2009 and March 2010. MAIN OUTCOME MEASURES: The respondents completed a questionnaire in English or Spanish, describing their use of bottled water and tap water for their children and rating their agreement with a series of belief statements about bottled water and tap water. Logistic regression was used to evaluate the association between bottled water use and beliefs and demographic characteristics with odds ratios (ORs). RESULTS: A total of 632 surveys were completed (35% white, 33% African American, and 32% Latino respondents). African American and Latino parents were more likely to give their children mostly bottled water; minority children were exclusively given bottled water 3 times more often than non-Latino white children (24% vs 8%, P < .01). In logistic regression analysis, the following factors were independently associated with mostly bottled water use: belief that bottled water is safer (OR, 2.4), cleaner (OR, 2.0), better tasting (OR, 2.8), or more convenient (OR, 1.7). After other factors were adjusted for, race/ethnicity, household income, and prior residence outside the United States were not associated with bottled water use. CONCLUSIONS: Minority parents are more likely to exclusively give bottled water to their children. Disparities in bottled water use are driven largely by differences in beliefs and perceptions about water. Interventions to reduce bottled water use among minority families should be based on knowledge of the factors that are related to water use in these communities.

Development and validation of a self-administered questionnaire to measure water exposures in children.

OBJECTIVE: To develop and validate a questionnaire to measure water exposures in children. METHODS: Caregivers of children younger than 18 years old evaluated in a pediatric emergency department completed a self-administered questionnaire with items about the child's exposure to water for drinking (15 items), hygiene (4 items), and recreation (5 items); other beverages (11 items); and other risk factors (11 items). Test-retest reliability was measured by administering the questionnaire to the same respondent within 48 hours. Concurrent validity was measured by having a second caregiver, when available, complete the same questionnaire independently. Agreement of paired responses was calculated by kappa (kappa) for categorical variables or Spearman rho (rho) correlation coefficient along with percentage mean difference for continuous variables. RESULTS: Ninety-four initial surveys were completed (45 subjects with diarrhea). All 94 completed retesting, while 23 had a second independently completed survey. Test-retest reliability (kappa or rho>0.6) was acceptable for 84% of items, and concurrent agreement was acceptable (kappa or rho>0.5) for 91% of items. CONCLUSIONS: This questionnaire has excellent test-retest and concurrent validity in measuring water exposures and other risk factors for gastrointestinal illness in children.