Objectives: Estimate the inter-rater reliability of critical care nurses performing a pediatric modification of the Glasgow Coma Scale in a contemporary PICU. Design: Prospective observation study. Setting: Large academic PICU. Patients/Subjects: All 274 nurses with permanent assignments in the PICU were eligible to participate. A subset of 18 nurses were selected as study registered nurses. All PICU patients were eligible to participate. Interventions: None. Measurements and Main Results: PICU nurses were educated and demonstrated proficiency on a pediatric modification of the Glasgow Coma Scale we created to make it more applicable to a diverse PICU population that included patients who are sedated, mechanically ventilated, and/or have developmental disabilities. Each study registered nurse observed a sample of nurses perform the Glasgow Coma Scale, and they independently scored the Glasgow Coma Scale. Patients were categorized as having developmental disabilities if their preillness Pediatric Cerebral Performance Category score was greater than or equal to 3. Fleiss’ Kappa (κ), intraclass correlation coefficient, and percent agreement assessed inter-rater reliability for each Glasgow Coma Scale component (eye, verbal, motor) and age-specific scale (≥ 2 and < 2-yr-old). The overall percent agreement between study registered nurses and nurses was 89% for the eye, 91% for the verbal, and 79% for the motor responses. Inter-rater reliability ranged from good (intraclass correlation coefficient = 0.75) to excellent (intraclass correlation coefficient = 0.96) for testable patients. Agreement on the motor response was significantly lower for children with developmental disabilities (< 2 yr: 59% vs 95%; p = 0.0012 and ≥ 2 yr: 55% vs 91%; p = 0.0012). Agreement was significantly worse for intermediate range Glasgow Coma Scale motor responses compared with responses at the extremes (e.g., motor responses 2, 3, 4 vs 1, 5, 6; p < 0.05). Conclusions: A pediatric modification of the Glasgow Coma Scale performed by trained PICU nurses has excellent inter-rater reliability, although reliability was reduced in patients with developmental disabilities and for intermediate range Glasgow Coma Scale responses. Further research is needed to determine the effectiveness of this Glasgow Coma Scale modification to detect clinical deterioration.

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Objective Computed tomography (CT) is used complementarily to radiography for the evaluation of medial coronoid disease (MCD). We hypothesized that a slice thickness > 2 mm would significantly affect the image quality and detection of fragmentation of the medial coronoid process. This study aimed to assess CT features indicating direct and indirect evidence of MCD in 168 CT studies with slice thicknesses of 1-, 2- and 3 mm. Materials and Methods The CT studies were blinded in terms of CT slice thickness and patient data and randomly assessed by two independent observers. All dogs underwent arthroscopic evaluation of the elbow joints. Both observers were unaware of the arthroscopic findings. Results Notably, blurring of the bone contour (p = 0.0001) was significantly influenced by slice thickness; here, a 1-mm thickness yielded a predominantly sharp and well-defined bone contour (observer 1, 91%; observer 2, 79%), whereas 2- (observer 1, 39.3%; observer 2, 56.3%) and especially 3-mm slice thicknesses yielded blurred margins with significantly reduced sharpness (observer 1, 0%; observer 2, 12.5%). The 1-mm slice thickness also yielded the highest fragment detection rate (observer 1, 55.4%; observer 2, 60.4%). Furthermore, the detection of fragment positions and of single fragments and fissures differed substantially with slice thickness. Clinical Relevance The findings of this study support the hypothesis that a CT slice thickness of ≥ 2 mm significantly affects fragment detection. In conclusion, a CT slice thickness of at least 1 mm is recommended for the assessment of MCD of the canine elbow.