Evaluating the test re-test reliability and inter-subject variability of Health Care Provider manual fluid resuscitation performance

Abstract

Background: Health Care Providers (HCPs) report that manual techniques of intravascular fluid resuscitation are commonly used during pediatric shock management. The optimal pediatric fluid resuscitation technique is currently unknown. We sought to determine HCP test-retest reliability (repeatability) and inter-subject variability of fluid resuscitation performance outcomes to inform the design of future studies.

Methods: Fifteen consenting HCPs from McMaster Children's Hospital, in Hamilton, Canada participated in this single-arm interventional trial. Participants were oriented to a non-clinical model representing a 15 kg toddler, which incorporated a 22-gauge IV catheter. Following a standardization procedure, participants administered 600 mL (40 mL/kg) of saline to the simulated child under emergency conditions using prefilled 60-mL syringes. Each participant completed 5 testing trials. All testing was video recorded, with fluid administration time outcome data (in seconds) extracted from trial videos by two blinded outcome assessors. Data describing catheter dislodgement events, volume of saline effectively delivered, and participant demographics were also collected. The primary outcome of fluid administration time test-retest reliability was analyzed by one-way analysis of variance (ANOVA) and intra-class correlation (ICC), with good reliability defined as ICC > 0.70.

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: Findings demonstrate excellent test-retest reliability of HCP fluid resuscitation performance in a setting involving a non-clinical model. Investigators can justify a single evaluation of HCP performance in future studies.

Figure 1

Pediatric fluid resuscitation model. A. Model Simulating 15 kg Child, B. Conduit Tubing, C. 1-Litre Graduated Cylinder, D. 1.00 inch, 22-gauge IV BD Insyte™ Autoguard IV catheter, E. Baxter 7.00 inch IV Catheter Extension Set, F. Baxter one-link needle-free IV connector.

Figure 2

The 'Disconnect-reconnect' technique of manual fluid resuscitation using syringes. 1. A Health Care Provider takes a syringe filled with isotonic fluid prepared by a colleague, 2. The Provider connects the syringe to the IV extension tubing, 3. The Provider administers the isotonic fluid contained within the syringe to the patient by depressing the syringe plunger. Steps 1–3 are repeated as quickly as possible until the desired volume of fluid had been administered.

Figure 3

Box-whisker plot of health care provider fluid administration time outcome data. The box-whisker plot provides a visual display of the distribution of outcome data for each participant. The boxes depict the interquartile range, with the solid horizontal line within the box representing the median. The whiskers illustrate the distribution of data outside the interquartile range. Circles denote outliers; asterisks denote extreme outliers.