Derivation of the DIVA score: a clinical prediction rule for the identification of children with difficult intravenous access.

Abstract:

OBJECTIVE:To develop a clinical prediction rule that would be easy to apply and be useful for predicting success or failure of peripheral intravenous line insertion in children. METHODS:This was a prospective cohort study of children aged 0 to 21 years undergoing peripheral intravenous placement by staff nurses in a pediatric emergency department. Information on candidate predictor variables was obtained before attempting intravenous placement, and the outcome was successful on first attempt. Backward stepwise logistic regression was used to identify factors independently predictive of success. Those factors remaining in the model were used in a set of linear scores. Receiver operating characteristic curves were constructed for each model, and the areas under the curve were calculated. RESULTS:Six hundred fifteen subjects were enrolled. Success rate for intravenous insertion on first attempt was 75%. A 4-variable proportionally weighted rule (known as the difficult intravenous access [DIVA] score) was created (3 points for prematurity, 3 for younger than 1 year, 1 for 1-2 years of age, 2 for vein not palpable, and 2 for vein not visible). The area under the receiver operating characteristic curve was 0.67. Subjects with a DIVA score of 4 or more were more than 50% likely to have failed intravenous placement on first attempt. CONCLUSIONS:A clinical prediction rule that is easy to apply and is useful for predicting success or failure of peripheral intravenous insertion has been created. If externally validated, this DIVA score can be used to predict which children will have difficult intravenous access.

journal_name

Pediatr Emerg Care

journal_title

Pediatric emergency care

authors

Yen K,Riegert A,Gorelick MH

doi

10.1097/PEC.0b013e3181666f32

subject

Has Abstract

pub_date

2008-03-01 00:00:00

pages

143-7

issue

3

eissn

0749-5161

issn

1535-1815

pii

00006565-200803000-00004

journal_volume

24

pub_type

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