Abstract 347: Experimental use of a Pediatric Fluid Resuscitation Model: Evaluating Test-retest Reliability and Inter-subject Variability
Introduction: Health Care Providers (HCPs) report that manual techniques of intravascular fluid resuscitation are commonly used to deliver isotonic fluid to young children. At present, it is unclear how manual fluid resuscitation is optimally performed by HCPs. A non-clinical experimental setting can be used to evaluate HCP fluid resuscitation performance outcomes, however test-retest reliability is unknown.
Objectives: To determine HCP test-retest reliability (repeatability) and inter-subject variability of fluid resuscitation performance outcomes to inform the design of future studies.
Hypothesis: We hypothesized that good test-retest reliability would be demonstrated, but that significant inter-subject variability would exist.
Methods: We conducted an interventional study involving 15 consenting HCP subjects from McMaster Children’s Hospital in Hamilton, Canada. Subjects were oriented to a non-clinical model of a 15 kg toddler. The model incorporated a 22-gauge IV catheter and extension tubing affixed to the hand in typical clinical fashion. Following a standardization procedure, subjects were asked to rapidly administer 600 mL (40 mL/kg) of 0.9% normal saline to the model using prefilled 60 mL syringes. Subjects were advised to consider that this was urgently required treatment for decompensated septic shock. Each subject repeated the intervention 5 times with a 10-minute washout period between trials. All testing was video recorded, with fluid administration time outcome data (in seconds) extracted from trial videos by two blinded outcome assessors. The primary outcome of fluid administration time test-retest reliability was analyzed by one-way ANOVA and ICC as per our a priori plan.
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: Our findings demonstrate excellent test-retest reliability of HCP fluid resuscitation performance in an experimental setting involving a non-clinical model. Use of a single HCP trial in future comparative studies is justified.
- © 2013 by American Heart Association, Inc.