Critique of the Canadian Acute Respiratory Illness and Flu Scale

Monique Bouvier; Ann M. Mayo


Pediatr Nurs. 2018;44(6):293-296. 

In This Article

Abstract and Introduction


Acute respiratory illness (ARI) is the most common clinical childhood illness. In 2010, there were approximately 15 million hospital admissions globally of children with acute lower respiratory tract infection. The estimated cost associated with acute respiratory infections (ARIs) in the United States is over 12 billion dollars annually, and yet there is a limited number of instruments available to assess and measure ARI severity, especially in children. One of the few instruments available is the Canadian Acute Respiratory Illness and Flu Scale (CARIFS). The purpose of this article is to present a critique of the psychometric properties of the CARIFS and if it produces valid data. Published studies were used to determine the reliability of the CARIFS. Although the CARIFS is one of the few pediatric instruments to capture ARI severity, it should be used with caution in the clinical and research settings. Further development and refinement of the instrument is recommended.


Nurses use a variety of clinical instruments to support their own practice and to recommend instruments to others within healthcare systems. Such examples include skin, fall, and pain scales. Taken on initial appearance, an instrument can appear to be a perfect fit for clinical practice, research, or quality improvement activities. However, not all instruments having initial face validity are entirely psychometrically sound. This critique of the Canadian Acute Respiratory Illness and Flu Scale (CARIFS) psychometric properties provides just such an example.

The CARIFS was originally developed for use in research to measure acute respiratory illness (ARI) disease severity among children (range 0 to 12 years) by capturing healthcare professionals' and parents' concerns with ARI (Jacobs et al., 2001). The instrument uses a list of symptoms, such as cough, fever, and care needs to measure the disease severity of ARI in children. Although developed for research purposes, there is evidence it is useful to pediatric clinicians in practice (Fischer, Prasad, Coffin, Alpern, & Mistry, 2014). For example, clinical nurse specialists (CNSs) and other professionals working in pediatrics who are accountable for the efficient use of healthcare resources when working with the pediatric population may find the CARIFS useful. Disease severity data collected with the CARIFS may provide pediatric healthcare providers with additional decision-making insight regarding the allocation of hospital resources.