Interrater Reliability of Clinical Findings in Children With Possible Appendicitis
Interrater Reliability of Clinical Findings in Children With Possible Appendicitis
复制标题
DOI：
10.1542/peds.2011-2037
复制
发表时间：
2012-04-01
期刊：
影响因子：
8
通讯作者：
Dayan, Peter S.
中科院分区：
文献类型：
--
作者：
Kharbanda, Anupam B.;Stevenson, Michelle D.;Dayan, Peter S.
目的：我们的目标是在一个大型的多中心队列中确定接受可能阑尾炎评估的儿童的临床病史和体检结果的评价者之间的可靠性。方法：我们对3-18岁可能患有阑尾炎的儿童进行了一项前瞻性、多中心、横断面研究。两名临床医生独立评估患者，并在60分钟内完成结构化病例报告表，而不知道诊断成像的结果。结果：共有811例患者完成了2次评估，其中599例(74%)在60分钟内完成了2次评估。75%的配对评估是由儿科急诊医生完成的。历史变量的原始符合率在64.9%到92.3%之间，6个变量中有4个具有中等的评价者间可靠性(kappa>；4)。疼痛持续时间(kappa=.56[95%可信区间.51-.61])和呕吐史(.84[.80-.89])的kappa值最高。对于体检变量，原始符合率在60.9%到98.7%之间，8个变量中有4个显示出中等可靠性。在体检变量中，伴有行走、跳跃或咳嗽的腹痛的卡伯值最高(0.54[.45-.63])，体检时有腹部压痛的卡伯值最高(0.49[.19-.80])。结论：评价者之间对患者病史和体检变量的可信度一般为中等至中等。这些变量具有较高的评价者间可靠性，更适合纳入可能患有阑尾炎的儿童的临床预测规则。儿科2012；129：695-700
OBJECTIVE: Our objective was to determine the interrater reliability of clinical history and physical examination findings in children undergoing evaluation for possible appendicitis in a large, multicenter cohort.METHODS: We conducted a prospective, multicenter, cross-sectional study of children aged 3-18 years with possible appendicitis. Two clinicians independently evaluated patients and completed structured case report forms within 60 minutes of each other and without knowing the results of diagnostic imaging. We calculated raw agreement and assessed reliability by using the unweighted Cohen kappa statistic with 2-sided 95% confidence intervals.RESULTS: A total of 811 patients had 2 assessments completed, and 599 (74%) had 2 assessments completed within 60 minutes. Seventy-five percent of paired assessments were completed by pediatric emergency physicians. Raw agreement ranged from 64.9% to 92.3% for history variables and 4 of 6 variables had moderate interrater reliability (kappa > .4). The highest kappa values were noted for duration of pain (kappa = .56 [95% confidence intervals .51-.61]) and history of emesis (.84 [.80-.89]). For physical examination variables, raw agreement ranged from 60.9% to 98.7%, with 4 of 8 variables exhibiting moderate reliability. Among physical examination variables, the highest kappa values were noted for abdominal pain with walking, jumping, or coughing (.54 [.45-.63]) and presence of any abdominal tenderness on examination (.49 [.19-.80]).CONCLUSIONS: Interrater reliability of patient history and physical examination variables was generally fair to moderate. Those variables with higher interrater reliability are more appropriate for inclusion in clinical prediction rules in children with possible appendicitis. Pediatrics 2012;129:695-700