Validating the Difficult Intravenous Access Clinical Prediction Rule

Abstract

This study aimed to evaluate the difficult intravenous access (DIVA) score, a clinical prediction rule, which states that children with a score of 4 or more will have a 50% higher rate of a failed intravenous placement on the first attempt compared with the mean failure rate. This was a prospective cohort study in children 0 to 14 years, undergoing peripheral intravenous placement by doctors in the emergency department of a medium-sized general hospital. Before intravenous placement attempts, demographic data inclusive of age and DIVA score were recorded. A maximum of 3 attempts per doctor were allowed, after which a more senior doctor undertook subsequent attempts. The site of successful placement was recorded. Five hundred children were enrolled. The male-female ratio was 1.3:1. One hundred thirty-three (26.6%) were less than 1 year, 103 (20.6%) were aged 1 to 2 years, and 264 (52.8%) were 3 years or older. One hundred ten children (22%) had a failed intravenous placement on the first attempt. Of the 151 children with a DIVA score of 4 or more, 57 (37.7%) had a failed intravenous placement, validating the clinical prediction rule. Only 5 subjects (1%) did not have intravenous placement after 6 attempts. This study validates DIVA score and provides a simple tool that can enhance the accuracy of the information offered to parents as it relates to the success rates of intravenous placement in children.