{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,20]],"date-time":"2026-04-20T22:31:57Z","timestamp":1776724317559,"version":"3.51.2"},"reference-count":32,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T00:00:00Z","timestamp":1694044800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000865","name":"Bill and Melinda Gates Foundation","doi-asserted-by":"publisher","award":["INV\u2010002559"],"award-info":[{"award-number":["INV\u2010002559"]}],"id":[{"id":"10.13039\/100000865","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Paediatrica"],"published-print":{"date-parts":[[2023,11]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To assess the inter\u2010rater reliability of modified Downes' scores assigned by physicians and nurses in the Ethiopian Neonatal Network and to calculate the concordance of score\u2010based treatment for preterm infants with respiratory distress.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>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\u2010based treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>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\u2010perfect agreement between nurse and physician assessments, translating to a very high degree of concordance in score\u2010based treatment recommendations. These results highlight an opportunity for task\u2010shifting assessments and empowering nurses.<\/jats:p><\/jats:sec>","DOI":"10.1111\/apa.16957","type":"journal-article","created":{"date-parts":[[2023,9,7]],"date-time":"2023-09-07T08:54:25Z","timestamp":1694076865000},"page":"2329-2337","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["High inter\u2010rater reliability between physicians and nurses utilising modified Downes' scores in preterm respiratory distress"],"prefix":"10.1111","volume":"112","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1215-1124","authenticated-orcid":false,"given":"Danielle E. Y.","family":"Ehret","sequence":"first","affiliation":[{"name":"Department of Pediatrics University of Vermont Larner College of Medicine  Burlington Vermont United\u00a0States"},{"name":"Vermont Oxford Network  Burlington Vermont United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Asrat","family":"Demtse\u00a0Gebremedhin","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health, College of Health Sciences  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amanuel","family":"Hadgu\u00a0Berhe","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health Mekelle University  Mekelle Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yohanes","family":"Hailu","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health University of Gondar  Gondar Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gesit","family":"Metaferia","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health St. Paul's Hospital Millennium Medical College  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kaitlin","family":"Kessler","sequence":"additional","affiliation":[{"name":"University of Vermont Medical Center  Burlington Vermont United\u00a0States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryan","family":"Kessler","sequence":"additional","affiliation":[{"name":"University of Vermont Medical Center  Burlington Vermont United\u00a0States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marie","family":"Dunn","sequence":"additional","affiliation":[{"name":"St. Michael's Hospital  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Agneta","family":"Golan","sequence":"additional","affiliation":[{"name":"Soroka Medical Center  Be'er Sheva Israel"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Miroslav","family":"Stavel","sequence":"additional","affiliation":[{"name":"Royal Columbian Hospital  New Westminster British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jaroslava","family":"Belava","sequence":"additional","affiliation":[{"name":"Vancouver Coastal Health  Vancouver British Columbia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6186-4927","authenticated-orcid":false,"given":"Jeffrey D.","family":"Horbar","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Vermont Larner College of Medicine  Burlington Vermont United\u00a0States"},{"name":"Vermont Oxford Network  Burlington Vermont United States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6611-1502","authenticated-orcid":false,"given":"Erika M.","family":"Edwards","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Vermont Larner College of Medicine  Burlington Vermont United\u00a0States"},{"name":"Vermont Oxford Network  Burlington Vermont United States"},{"name":"University of Vermont College of Engineering and Mathematical Sciences  Burlington Vermont United\u00a0States"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bogale","family":"Worku","sequence":"additional","affiliation":[{"name":"Ethiopian Pediatrics Society  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Dunn","sequence":"additional","affiliation":[{"name":"Department of Paediatrics University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mahlet","family":"Abayneh","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Child Health St. Paul's Hospital Millennium Medical College  Addis Ababa Ethiopia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2023,9,7]]},"reference":[{"key":"e_1_2_11_2_1","unstructured":"World Health Organization.Newborn mortality.2022.https:\/\/www.who.int\/news\u2010room\/fact\u2010sheets\/detail\/levels\u2010and\u2010trends\u2010in\u2010child\u2010mortality\u2010report\u20102021"},{"key":"e_1_2_11_3_1","unstructured":"Survive and Thrive: Transforming Care for every Small and Sick Newborn. Key Findings. World Health Organization;2018."},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2352-4642(21)00311-4"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214-109X(19)30220-7"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.21037\/tp.2019.07.01"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1177\/000992287000900607"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022-3476(05)82056-6"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2431-13-59"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.7199\/ped.oncall.2016.30"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.7499\/j.issn.1008-8830.2110023"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1177\/2333794X211007464"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.16554"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.03438"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.15671"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41372-018-0049-3"},{"key":"e_1_2_11_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.15142"},{"key":"e_1_2_11_18_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12098-022-04199-9"},{"key":"e_1_2_11_19_1","unstructured":"Quality equity dignity: the network to improve quality of care for maternal newborn and child health\u2010strategic objectives.2018."},{"key":"e_1_2_11_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)60496-7"},{"key":"e_1_2_11_21_1","volume-title":"An Action Plan to End Preventable Deaths","author":"Every Newborn","year":"2014"},{"key":"e_1_2_11_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.semperi.2021.151412"},{"key":"e_1_2_11_23_1","doi-asserted-by":"publisher","DOI":"10.1159\/000496214"},{"key":"e_1_2_11_24_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0228915"},{"key":"e_1_2_11_25_1","doi-asserted-by":"publisher","DOI":"10.1186\/s40985-020-00124-7"},{"key":"e_1_2_11_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/apa.16050"},{"key":"e_1_2_11_27_1","doi-asserted-by":"publisher","DOI":"10.1111\/inr.12510"},{"key":"e_1_2_11_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12913-021-06680-1"},{"key":"e_1_2_11_29_1","unstructured":"Sustainable Development Goals.2020.https:\/\/sustainabledevelopment.un.org\/sdg3"},{"key":"e_1_2_11_30_1","doi-asserted-by":"publisher","DOI":"10.3389\/fped.2022.961509"},{"key":"e_1_2_11_31_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD002271.pub3"},{"key":"e_1_2_11_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/14651858.CD001243"},{"key":"e_1_2_11_33_1","doi-asserted-by":"publisher","DOI":"10.1038\/jp.2016.29"}],"container-title":["Acta Paediatrica"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/apa.16957","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,1,23]],"date-time":"2024-01-23T08:32:50Z","timestamp":1705998770000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/apa.16957"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,9,7]]},"references-count":32,"journal-issue":{"issue":"11","published-print":{"date-parts":[[2023,11]]}},"alternative-id":["10.1111\/apa.16957"],"URL":"https:\/\/doi.org\/10.1111\/apa.16957","archive":["Portico"],"relation":{},"ISSN":["0803-5253","1651-2227"],"issn-type":[{"value":"0803-5253","type":"print"},{"value":"1651-2227","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,9,7]]},"assertion":[{"value":"2023-05-18","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-08-18","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-09-07","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}