Approaches to describing inter-rater reliability of the overall clinical appearance of febrile infants and toddlers in the emergency department

Abstract

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.

A standardized imaging protocol improves quality and reduces practice variability in echocardiographic assessment of ventricular function by first‐year pediatric cardiology fellows

“…12 Gwet's AC 1 was chosen due to its superior performance compared to Light's kappa in the setting of high inter-rater agreement. 13,14 Excellent agreement was defined as an AC 1 > 0.80 and good agreement an AC 1 > 0.60. As the distributions of these scores were not normal, they were compared between the pre-and postintervention groups using the Wilcoxon rank-sum test.…”

Validation of data submitted by the treating surgeon in the Victorian Audit of Surgical Mortality

“…Gwet's AC1 scores were chosen over Cohen's kappa as they are less affected by prevalence and marginal probability. 11,12 An agreement percentage was used for the nominal variables. The null hypothesis of each P-value test is that the Gwet's AC1 score is equal to zero.…”

The International Classification of the radiological Complexity (ICC) of frontal recess and frontal sinus

“…We also assessed the different classification systems for interrater agreement. In this study, we chose Gwet's Agreement Coefficient 2 (AC2) to assess interrater agreement, which offers a statistic that: (1) can be used with more than 2 raters; (2) can be used for ordinal variables; (3) is able to handle missing data; and (4) has been previously used and recommended in previous studies . The interrater agreement coefficient of classification system A (0.52) falls between that of B (0.42) and C (0.79).…”