Evaluation of the Difficult Intravenous Access (DIVA) Scoring in Hospitalized Pediatric Patients
The DIVA scoring tool has previously been validated in the pediatric ED setting. Our project applied DIVA to an inpatient pediatric sample. DIVA may not predict likelihood of PIV success in the inpatient setting. First-attempt success rate for placing pediatric peripheral intravenous (PIV) catheters ranges from to 24% to 52%. Multiple attempts can increase risk of deleterious outcomes. It is essential to screen pediatric patients appropriately to identify those who will require additional resources for successful PIV placement. A convenience sample of hospitalized pediatric patients 0 to 18 years of age on a general care unit was used in this performance improvement project. Prior to attempting PIV access, nurses completed a data collection tool that included elements of established difficult intravenous access (DIVA) tools as well as first-attempt successful PIV placement. The primary outcome measure was to determine if each DIVA scoring tool is accurate in predicting the need for additional resources to achieve successful first-attempt PIV placement. The secondary outcome measure was to compare the predictive value of each DIVA scoring tool among an inpatient pediatric population. Following data exploration and cleaning, a correlation analysis was performed with logistic regression to assess DIVA score effectiveness in predicting success of PIV insertion on the first attempt. Out of 133 children, 167 PIV attempts were analyzed with 150 PIV attempts included in the final data analysis. Of the 150 PIV attempts analyzed, 60% (n = 90) were successful on the first attempt. Performance of prediction for first-time insertion success was comparable among all 4 DIVA scoring tools. None of the 4 DIVA scoring tools were superior in predicting first-time PIV placement among hospitalized children. Vein palpability was more predictive, although not statistically significant.Highlights
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Correlation matrix calculated for all variables used in this study. A separate correlation was calculated between each collected variable as well as the calculated DIVA scores. Darker colors are associated with lower (negative) correlations while lighter colors indicate higher correlations.
Resulting area under the curve plots for each DIVA scoring method following logistic regression. Each color represents a DIVA score type. The black dotted line shows an area under the curve of 0.5. The data shown is for 1 logistic regression iteration.
Logistic regression sensitivity analysis. Resulting area under curve values following 1000 logistic regression iterations. Each iteration is a random shuffle of the data with 80% used for training and 20% for testing. The iterations are displayed on the x-axis and the resulting accuracies on the y-axis.
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