Interexaminer Reliability in Physical Examination of Pediatric Patients With Abdominal Pain

Yen, Kenneth; Karpas, Anna; Pinkerton, Heidi J.; Gorelick, Marc H.

doi:10.1001/archpedi.159.4.373

Cited by 53 publications

(35 citation statements)

References 11 publications

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“…La localización del dolor en fosa iliaca derecha establece una pequeña relación con respecto a la apendicitis aguda, presentando una exactitud de 76,5%, siendo el índice J de Jouden de 0,6 y la razón de verosimilitud (CPP o LR+) de 5,98 con un IC al 95% (2,(3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)68). Con respecto a la relación entre la localización del dolor en hipocondrio y la colecistitis esta presenta un incremento amplio con LR+ de 26.14 con IC al 95% (6,.…”

Section: Resultsunclassified

“…Realizamos una revisión de las historias clínicas de estos enfermos, extrayendo datos sociodemográficos, antecedentes personales de cirugía previa, síntomas asociados, localización del dolor y tipo del mismo. Dentro del examen físico se tuvieron en cuenta la presencia o no de signos clínicos generales (hipotensión/hipoperfusión, taquicardia y fiebre), así como signos clínicos de la exploración abdominal: la presencia o ausencia de distensión abdominal, masas palpables, masas pulsátiles, así como diferentes signos de irritación peritoneal (7).…”

Section: Materials Y Métodosunclassified

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Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department

Fernandez

López

Montes

et al. 2009

Rev. esp. enferm. dig.

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Objective: to determine the real importance of anamnesis, physical examination, and various tests in the assessment of acute abdominal pain.Methods: a retrospective observational study with patients complaining of abdominal pain at the Emergency Department, Altiplano Health Area (Murcia) was performed. In our study we considered the following variables: socio-demographic data, history of previous surgery, symptoms, place and type of pain. Imaging tests were labeled as positive, negative, or inconclusive for assumed diagnoses, which were retrospectively assessed by an external radiologist who was unaware of the patient's final diagnosis.Results: our study includes 292 patients with a mean age of 45.49 years; 56.8% of these patients were women. Regarding the frequency of the different acute abdomen diagnoses, appendicitis was the main cause (approx. 25%), followed by cholecystitis (10%). We found a significant diagnostic correlation between pain location in the right hypochondrium (RHC) and a diagnosis with cholecystitis. This location was also significant for acute appendicitis (up to 74%). Regarding clinical signs, we only observed a significant correlation between fever and viscera perforation, and between Murphy's sign and cholecystitis. Sensitivity and specificity found in relation to the psoas sign were similar to those seen in other series, 16 and 95% respectively, and slightly lower than the Blumberg or rebound sign, which we found to be around 50 and 23%, respectively.Conclusions: a) anamnesis and physical examination offer limited accuracy when assessing acute abdomen; b) ultrasound scans offer a low diagnostic agreement index for appendicitis; and c) laparoscopy may prove useful for diagnosis, and is also a possible treatment for acute abdominal pain despite its low diagnostic efficiency.

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Section: Resultsunclassified

Section: Materials Y Métodosunclassified

Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department

Fernandez

López

Montes

et al. 2009

Rev. esp. enferm. dig.

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“…19,30 This had two effects on agreement. First, both nurses did not gather the same information, and this could decrease agreement.…”

Section: Limitationsmentioning

confidence: 99%

Interrater Agreement between Nurses for the Pediatric Canadian Triage and Acuity Scale in a Tertiary Care Center

Gravel¹,

Gouin²,

Manzano³

et al. 2008

Academic Emergency Medicine

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Objectives: The objective was to measure the interrater agreement between nurses assigning triage levels to children visiting a pediatric emergency departments (EDs) assisted by a computerized version of the Pediatric Canadian Triage and Acuity Scale (PedCTAS).Methods: This was a prospective cohort study evaluating children triaged from Level 2 (emergent) to Level 5 (nonurgent). A convenience sample of patients triaged during 38 shifts from April to September 2007 in a tertiary care pediatric ED was evaluated. All patients were initially triaged by regular triage nurses using a computerized version of the PedCTAS. Research nurses performed a second evaluation blinded to the first evaluation using the same triage tool. These research nurses were regular ED nurses performing extra hours for research purposes exclusively. The primary outcome measure was the interrater agreement between the two nurses as measured by the linear weighted kappa score. Secondary outcomes included the proportion of patient for which nurses did not apply the triage level suggested by Staturg (override) and agreement for these overrides.Results: A total of 499 patients were recruited. The overall interrater agreement was moderate (linear weighted kappa score of 0.55 [95% confidence interval {CI} = 0.48 to 0.61] and quadratic weighted kappa score of 0.61 [95% CI = 0.42 to 0.80]). There was a discrepancy of more than one level in only 10 patients (2% of the study population). Overrides occurred in 23.2 and 21.8% for regular and research triage nurses, respectively. These overrides were equally distributed between increase and decrease in triage level.Conclusions: Nurses using Staturg, which is a computerized version of the PedCTAS, demonstrated moderate interrater agreement for assignment of triage level to children presenting to a pediatric ED.ACADEMIC EMERGENCY MEDICINE 2008; 15:1262-1267

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“…A thorough physical examination in combination with the history is the primary source of initial information for any clinician1, 2 and influences decision making for further diagnostic and therapeutic intervention 3. Examinations should therefore have good reliability (how well can patients be distinguished from each other), high agreement (low measurement error for repeated assessments)4 and results of the examination should be valid (accurate) 5.…”

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confidence: 99%

Rater Agreement on Gait Assessment during Neurologic Examination of Horses

Olsen

Dunkel

Barker

et al. 2014

Veterinary Internal Medicne

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BackgroundReproducible and accurate recognition of presence and severity of ataxia in horses with neurologic disease is important when establishing a diagnosis, assessing response to treatment, and making recommendations that might influence rider safety or a decision for euthanasia.ObjectivesTo determine the reproducibility and validity of the gait assessment component in the neurologic examination of horses.AnimalsTwenty‐five horses referred to the Royal Veterinary College Equine Referral Hospital for neurological assessment (n = 15), purchased (without a history of gait abnormalities) for an unrelated study (n = 5), or donated because of perceived ataxia (n = 5).MethodsUtilizing a prospective study design; a group of board‐certified medicine (n = 2) and surgery (n = 2) clinicians and residents (n = 2) assessed components of the equine neurologic examination (live and video recorded) and assigned individual and overall neurologic gait deficit grades (0–4). Inter‐rater agreement and assessment‐reassessment reliability were quantified using intraclass correlation coefficients (ICC).ResultsThe ICCs of the selected components of the neurologic examination ranged from 0 to 0.69. “Backing up” and “recognition of mistakes over obstacle” were the only components with an ICC > 0.6. Assessment‐reassessment agreement was poor to fair. The agreement on gait grading was good overall (ICC = 0.74), but poor for grades ≤ 1 (ICC = 0.08) and fair for ataxia grades ≥ 2 (ICC = 0.43). Clinicians with prior knowledge of a possible gait abnormality were more likely to assign a grade higher than the median grade.Conclusion and Clinical ImportanceClinicians should be aware of poor agreement even between skilled observers of equine gait abnormalities, especially when the clinical signs are subtle.

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Interexaminer Reliability in Physical Examination of Pediatric Patients With Abdominal Pain

Cited by 53 publications

References 11 publications

Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department

Validity of tests performed to diagnose acute abdominal pain in patients admitted at an emergency department

Interrater Agreement between Nurses for the Pediatric Canadian Triage and Acuity Scale in a Tertiary Care Center

Rater Agreement on Gait Assessment during Neurologic Examination of Horses

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