Evaluation of a Pediatric Respiratory Assessment Tool: Inter-Rater Agreement and Correlation to Duration of Heated High-Flow Nasal Cannula Therapy

Background: We implemented a heated high-flow nasal cannula (HHFNC) protocol utilizing a respiratory assessment-scoring tool to guide interventions in therapy. Providers from two different disciplines used the respiratory assessment-scoring tool. We sought to characterize the inter-rater agreement between nursing and respiratory therapy assessments when using a pediatric respiratory scoring tool for infants with bronchiolitis and explore if a higher score obtained on the first day of use was associated with a longer duration of HHFNC use. Methods: All subjects that qualified for the HHFNC protocol were included in the study. A total of 28 infants with uncomplicated bronchiolitis were admitted to the acute care pediatric unit and placed on the HHFNC protocol. A respiratory assessment utilizing the scoring tool was performed independently every four hours by a respiratory therapist (RT) and registered nurse (RN). The nurse and therapist were not allowed to compare scores. The first assessment for each patient was placed in a binary classifier of a high (>8) or low ( Results: A total of 319 simultaneous assessments were compared between providers. Percent agreement is shown for each element of the scoring system in the table as well as the average score for each element per provider when a disagreement was present. The highest percent agreement was found with breathing frequency. The lowest agreement was found for auscultation and retractions. For the element with the lowest percent agreement (retractions) RNs tended to assign higher scores than that the RTs when disagreements were present. When looking at a binary classifier for the score, a high score from the RTs on the first day was associated with a longer median duration of HHFNC use, 75 vs.51 h (P Conclusions: Elements from the scoring tool involving objective measurements such as respiratory rate resulted in strong agreement but elements involving subjective measurements such as auscultation and retractions resulted in weaker agreement. Higher-rated respiratory scores assessed on the first day were associated with a longer duration of HHFNC use.