High inter-rater reliability between physicians and nurses utilising modified Downes' scores in preterm respiratory distress

Danielle E Y Ehret; Asrat Demtse Gebremedhin; Amanuel Hadgu Berhe; Yohanes Hailu; Gesit Metaferia; Kaitlin Kessler; Ryan Kessler; Marie Dunn; Agneta Golan; Miroslav Stavel; Jaroslava Belava; Jeffrey D Horbar; Erika M Edwards; Bogale Worku; Michael Dunn; Mahlet Abayneh

doi:10.1111/apa.16957

High inter-rater reliability between physicians and nurses utilising modified Downes' scores in preterm respiratory distress

Acta Paediatr. 2023 Nov;112(11):2329-2337. doi: 10.1111/apa.16957. Epub 2023 Sep 7.

Authors

Danielle E Y Ehret^{1

2}, Asrat Demtse Gebremedhin³, Amanuel Hadgu Berhe⁴, Yohanes Hailu⁵, Gesit Metaferia⁶, Kaitlin Kessler⁷, Ryan Kessler⁷, Marie Dunn⁸, Agneta Golan⁹, Miroslav Stavel¹⁰, Jaroslava Belava¹¹, Jeffrey D Horbar^{1

2}, Erika M Edwards^{1

2

12}, Bogale Worku¹³, Michael Dunn¹⁴, Mahlet Abayneh⁶

Affiliations

¹ Department of Pediatrics, University of Vermont Larner College of Medicine, Burlington, Vermont, United States.
² Vermont Oxford Network, Burlington, Vermont, United States.
³ Department of Pediatrics and Child Health, College of Health Sciences, Addis Ababa, Ethiopia.
⁴ Department of Pediatrics and Child Health, Mekelle University, Mekelle, Ethiopia.
⁵ Department of Pediatrics and Child Health, University of Gondar, Gondar, Ethiopia.
⁶ Department of Pediatrics and Child Health, St. Paul's Hospital Millennium Medical College, Addis Ababa, Ethiopia.
⁷ University of Vermont Medical Center, Burlington, Vermont, United States.
⁸ St. Michael's Hospital, Toronto, Ontario, Canada.
⁹ Soroka Medical Center, Be'er Sheva, Israel.
¹⁰ Royal Columbian Hospital, New Westminster, British Columbia, Canada.
¹¹ Vancouver Coastal Health, Vancouver, British Columbia, Canada.
¹² University of Vermont College of Engineering and Mathematical Sciences, Burlington, Vermont, United States.
¹³ Ethiopian Pediatrics Society, Addis Ababa, Ethiopia.
¹⁴ Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada.

PMID: 37675588
DOI: 10.1111/apa.16957

Abstract

Aim: To assess the inter-rater reliability of modified Downes' scores assigned by physicians and nurses in the Ethiopian Neonatal Network and to calculate the concordance of score-based treatment for preterm infants with respiratory distress.

Methods: We included preterm infants admitted from June 2020 to July 2021 to four tertiary neonatal intensive care units (NICUs) of the Ethiopian Neonatal Network that presented with respiratory distress. We calculated the kappa statistic to determine the nurse and physician correlation for each component of the modified Downes' score and total score on admission and evaluated the concordance of scores above and below the treatment threshold of 4.

Results: Of the 1151 eligible infants admitted, 817 infants (71%) had scores reported concurrently and independently by nurse and physician. The kappa statistic for modified Downes' score components ranged from 0.88 to 0.92 and was 0.89 for the total score. There was 98% concordance for score-based treatment.

Conclusion: Incorporation of the modified Downes' score on admission for preterm infants with respiratory distress was feasible in tertiary NICUs in Ethiopia. The kappa statistics showed near-perfect agreement between nurse and physician assessments, translating to a very high degree of concordance in score-based treatment recommendations. These results highlight an opportunity for task-shifting assessments and empowering nurses.

Keywords: continuous positive airway pressure; downes' score; neonatal mortality; neonatal nursing; respiratory distress syndrome.

Abstract

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