Aim/goal of project
The use of severity scoring tools has been commonly used to help clinicians assess severity of bronchiolitis; however there are limitations to current tools used. Very few tools have been validated and those that have are often modified to suit specific research, thus limiting the generalisability to other populations.

Primary aim is to determine the validity and reliability of a bronchiolitis scoring system in children aged <24 months presenting to Royal Darwin Hospital with bronchiolitis.

Secondary aims are to determine whether the score can predict the need for oxygen administration. We also plan to develop a respiratory educational DVD that will help health professionals assess and manage bronchiolitis in particular young Indigenous children.

Hypothesis
A clinical severity scoring system for bronchiolitis that is valid and predictive of requirement for oxygen can be developed
 
Background
Bronchiolitis remains the most common acute lower respiratory tract infection (ALRTI). Northern Territory Indigenous infants have the highest reported hospitalisations of bronchiolitis globally affecting 352 per 1000 (1 in 5); rates higher than American Indians, Alaskan Natives and developing countries. In a retrospective study in Darwin, Indigenous children with bronchiolitis had more severe disease than non Indigenous children but there was no difference in viral pathogens.

Recognition of severity of bronchiolitis is essential for good management. However, assessing and describing respiratory severity of infant’s is challenging for health staff, in particular in remote communities. These remote practitioners vary widely in their levels of paediatric experience. Severity scoring tools have been used to help describe clinical parameters and clinical outcomes such as wheezing, retractions and respiratory rate; however they are complex and have been described for very short term assessment (i.e. minutes to hours). Applicability of these scoring tools to different populations and settings are arguably limited. Indeed, while many scores exist, there is currently no validated bronchiolitis scoring system that is beyond the immediate setting. Also none can be feasibly used in remote settings.

This study will help establish if a standardised severity scoring tool can be a useful predictor of disease severity for bronchiolitis in our setting and can transferable to other populations/settings. A secondary outcome of this study will include the development of a respiratory educational DVD. This DVD will include assessment of wheeze and chest crackles as well as clips depicting normal, mild, moderate and severe respiratory distress. This will provide visual support for health providers of varying levels of experience to identify respiratory distress severity. This is important for health staff that have varying experiences in hospital and remote communities. In most remote communities, patients are treated by nurses and Indigenous Health Workers acutely with doctors available as a backup remotely. Thus accurate assessment is important for good clinical care and the proposed DVD will fulfil a known clinical gap. Also, the DVD will subsequently be made freely available on an Indigenous-specific web-based repository for health resources, which will increase research transfer of the project outcomes.

Interesting information
84 children have been currently enrolled. We will finish recruiting for this study at the end of 2011.

Links/newsletters
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