Journal of Medical Statistics and Informatics ISSN 2053-7662 | Volume 2 | Article 6 Original Open Access Exploring the use of negative binomial regression modeling for pediatric peripheral intravenous catheterization Jennifer Mann 1 , Pamela Larsen 2 and Jason Brinkley 3* Abstract A large study conducted at two southeastern US hospitals from October 2007 through October 2008 sought to identify predictive variables for successful intravenous catheter (IV) insertion, a procedure that is potentially difficult and time consuming. The data was collected on a sample of 592 children who received a total of 1195 attempts to start peripheral IV catheters in the inpatient setting. The median age of the children was 2.25 years, with an age range of 2 days to 18 years. Previous published studies did not fully utilize all aspects of the data. In particular it is proposed that the underlying data appears to have a negative binomial structure. While negative binomial regression is a popular technique for overdispersed Poisson data, there are few published studies and available datasets that utilize negative binomial regression on negative binomial data. The goal of this study is to determine the appropriateness of and use negative binomial regression to re-examine this data. Keywords: Negative binomial regression, intravenous catheter insertion, predictive variables, poisson data © 2014 Brinkley et al. licensee Herbert Publications Ltd. his is an Open Access article distributed under the terms of Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0). his permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction For pediatric hospital patients in need of fluids quickly, successfully inserting a peripheral intravenous catheter, commonly known as an IV, is often a medical necessity and critical first step in treatment. The process involves a hollow, metal needle that is beveled at one end and sheathed in a plastic catheter tube [1]. Once the needle has been successfully placed in the lumen, or interior, of the vein, the catheter is pushed over the end of needle. The metal component is then removed from the vein, leaving the catheter in place. This process is necessary to infuse needed fluids and/or medications into the body while preventing swelling in the patient. The process of IV placement is unique in that there are very few alternatives to it, so in virtually all cases the process must be performed until it is successful. For pediatric patients, the procedure can be particularly difficult and time consuming. Factors such as patient age and unfamiliarity with the process present difficulties in pediatric IV placement. It is not uncommon for the process to require several separate needle stick attempts for a single patient. Previous studies have been conducted to research the factors that impact successful IV insertion. Gorelick [2] studied 615 children aged 0-21 years who underwent peripheral intravenous catheter placement by staff nurses in a pediatric emergency department. Information on predictor variables was obtained before attempting intravenous placement, as well as whether the outcome was successful on the first attempt. Backward stepwise logistic regression was used to identify factors independently predictive of success. The study concluded that patients exhibiting prematurity, under the age of 1, or between the ages of 1 and 2, could be assessed different difficulty scores. Larsen [3] and Goff [4] studied 592 children ages 0-18 who underwent pediatric IV catheter insertions in the inpatient setting at two southeastern US teaching hospitals. Larsen [3] sought to identify the predictive variables for successful IV insertion. The data was analyzed using a combination of a logistic regression model for success on first attempt, repeated measures logistic regression across multiple stick attempts, and a proportional hazards model on time to success. Larsen’s results indicated that shift (day versus night), health professional perception of difficulty of the IV insertion, and the level of cooperation of the child all significantly contributed to the odds of a higher than usual number of IV attempts. The published regression models for the Larsen study may not have fully utilized all aspects of the data. Specifically, none *Correspondence: brinkleyj@ecu.edu 1 Department of Statistics, The Ohio State University, USA. 2 Department of Pediatrics, Brody School of Medicine, East Carolina University, USA. 3 Department of Biostatistics, College of Allied Health Sciences, East Carolina University, USA. CrossMark ← Click for updates