Objectives. To measure inter-rater agreement of overall clinical appearance of febrile children aged less than 24 months and to compare methods for doing so.Study Design and Setting. We performed an observational study of inter-rater reliability of the assessment of febrile children in a county hospital emergency department serving a mixed urban and rural population. Two emergency medicine healthcare providers independently evaluated the overall clinical appearance of children less than 24 months of age who had presented for fever. They recorded the initial ‘gestalt’ assessment of whether or not the child was ill appearing or if they were unsure. They then repeated this assessment after examining the child. Each rater was blinded to the other’s assessment. Our primary analysis was graphical. We also calculated Cohen’s κ, Gwet’s agreement coefficient and other measures of agreement and weighted variants of these. We examined the effect of time between exams and patient and provider characteristics on inter-rater agreement.Results. We analyzed 159 of the 173 patients enrolled. Median age was 9.5 months (lower and upper quartiles 4.9–14.6), 99/159 (62%) were boys and 22/159 (14%) were admitted. Overall 118/159 (74%) and 119/159 (75%) were classified as well appearing on initial ‘gestalt’ impression by both examiners. Summary statistics varied from 0.223 for weighted κ to 0.635 for Gwet’s AC2. Inter rater agreement was affected by the time interval between the evaluations and the age of the child but not by the experience levels of the rater pairs. Classifications of ‘not ill appearing’ were more reliable than others.Conclusion. The inter-rater reliability of emergency providers’ assessment of overall clinical appearance was adequate when described graphically and by Gwet’s AC. Different summary statistics yield different results for the same dataset.

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As the understanding of temporomandibular disorders' (TMDs) aetiologies and treatments develops from non-evidence-based to evidence-based approaches, the availability of sound information will likewise grow and need to be disseminated. The purpose of this study is to describe the content most commonly viewed in YouTube videos related to TMDs or "TMJ" and see whether videos from different sources have different content. Video information was gathered by searching YouTube for the term "TMJ," and data were recorded related to descriptive information as well as content. Statistical analyses included Kruskal-Wallis H Test, Spearman's Rho and univariate logistic regression. The sources of upload were Consumer (n = 62), Professional (n = 29) and News (n = 9). There were almost no statistically significant differences in content distribution among video sources. Videos garnered a total of 4 749 360 views, with an overall median of 7014.5 views. About two-thirds of the videos (68/100) explained what "TMJ" is, with a surprising third of Professional videos (9/29) not covering the subject. Roughly half of the videos mentioned at least one reason "TMJ" occurs (55/100), and seven in ten mentioned some kind of treatment (70/100). Video names mentioned a cure or treatment in 64 cases, while the other 36 referred to TMJ anatomy or "TMJ" aetiology. Future research should focus on ways to popularise professional videos with reliable information for those who are searching on YouTube for advice related to "TMJ."

Objectives To measure inter-rater agreement of overall clinical appearance of febrile children aged less than 24 months and to compare methods for doing so. Study Design and setting We performed an observational study of inter-rater reliability of the assessment of febrile children in a county hospital emergency department serving a mixed urban and rural population. Two emergency medicine healthcare providers independently evaluated the overall clinical appearance of children less than 24 months of age who had presented for fever. They recorded the initial ‘gestalt’ assessment of whether or not the child was ill appearing or if they were unsure. They then repeated this assessment after examining the child. Each rater was blinded to the other’s assessment. Our primary analysis was graphical. We also calculated Cohen’s κ, Gwet’s agreement coefficient and other measures of agreement and weighted variants of these. We examined the effect of time between exams and patient and provider characteristics on inter-rater agreement. Results We analyzed 159 of the 173 patients enrolled. Median age was 9.5 months (lower and upper quartiles 4.9-14.6), 99/159 (62%) were boys and 22/159 (14%) were admitted. Overall 118/159 (74%) and 119/159 (75%) were classified as well appearing on initial ‘gestalt’ impression by both examiners. Summary statistics varied from 0.223 for weighted κ to 0.635 for Gwet’s AC2. Inter rater agreement was affected by the time interval between the evaluations and the age of the child but not by the experience levels of the rater pairs. Classifications of ‘not ill appearing’ were more reliable than others. Conclusion The inter-rater reliability of emergency providers' assessment of overall clinical appearance was adequate when described graphically and by Gwet’s AC. Different summary statistics yield different results for the same dataset.

Objective To measure the performance characteristics of an immunochromatographic rapid antigen test for respiratory syncytial virus (RSV) and determine how its interpretation should be contextualized in patients presenting to the emergency department (ED) with bronchiolitis. Design Diagnostic accuracy study of a rapid RSV test. Setting County hospital emergency department. Intervention We took paired nasal samples from consecutively enrolled infants with bronchiolitis and tested them with a rapid immunochromatographic antigen test and reverse transcriptase polymerase chain reaction gold standard. Outcome measures Sensitivity, specificity, likelihood ratios, predictive values, evidence of spectrum bias and clinical characteristics of the patients. Using these we constructed a graphical contextual model to show how the results of RSV antigen tests from infants presenting within 24 hours should influence interpretation of subsequent antigen tests. Results We analyzed 607 patients. The sensitivity and specificity for immunochromatographic testing was 79.4% (95% CI 73.9%, 84.2%) and 67.1% (95% CI 61.9%, 72%) respectively. We found little evidence of spectrum bias. In our contextual model the best predictor of a positive RT-PCR test was a positive antigen test OR 5.47 (95%CI 3.65, 8.18) and the number of other infants having positive tests within 24 hours OR 1.48 (95%CI 1.26, 1.72) per infant. Increasing numbers presenting to the ED with bronchiolitis in a given day increases the probability of RSV infection. Conclusion The RSV antigen test we examined had modest performance characteristics. The results of the antigen test should be interpreted in the context of the results of previous tests.