Development and Evaluation of the Mini Congestion Score in Patients with Acute Heart Failure
DOI:
https://doi.org/10.60099/jtnmc.v39i04.270082Keywords:
fluid congestion, heart failure, assessment toolAbstract
Introduction Congestion is the primary reason patients with acute heart failure require hospitalization. A standardized, user-friendly, and accurate bedside tool for assessing fluid status could assist nurses in evaluating the severity and progression of fluid overload, improving care decisions and communication with physicians.
Objective To develop and evaluate the quality of the mini congestion score (MCS) in assessing congestion among patients with acute heart failure
Design Research and development
Methodology The development of the MCS assessment tool for fluid congestion followed a three-phase evidence-based nursing framework of the advanced nursing practice center: 1) clinical problem identification (evidence triggered), 2) evidence review and retrieval (evidence supported), and 3) tool implementation and outcome evaluation (evidence observed). The MCS and a nurse user manual were developed based on 14 retrieved and quality-appraised evidence items, following the Joanna Briggs Institute criteria. To assess its effectiveness, the MCS was tested in 50 critically ill patients admitted to the medical intensive care unit to evaluate fluid congestion.
Results The MCS consisted of an assessment of jugular venous pressure, rales, and edema, with a score of 0-3 for each item. The overall score of the tool is interpreted as including no congestion (score = 0), mild congestion (score = 1-3), moderate congestion (score = 4-6), and severe congestion (score = 7-9). Inter-rater reliability analysis revealed a very good level (Intraclass correlation coefficient = .980, 95%CI = .964 - .989, p<.001). The efficiency test of the MCS revealed that, at the cut-off of 3, the MCS had a sensitivity of 90.7%, specificity of 94.7%, and an area under the receiver operating characteristics curve (AUC) of .962 (95%CI = .909 – 1.00, p<.001)
Recommendation The MCS tool effectively evaluates and monitors fluid congestion during treatment. Its user-friendly design allows nurses to learn to use it independently with the provided manual. To optimize accuracy, it is recommended to combine its use with the hospital’s standard fluid congestion assessment protocol.
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