Interobserver Agreement in Assessment of Clinical Variables in Children with Blunt Head Trauma

Gorelick, Marc H.; Atabaki, Shireen M.; Hoyle, John D.; Dayan, Peter; Holmes, James F.; Holubkov, Richard; Monroe, David; Callahan, James M.; Kuppermann, Nathan

doi:10.1111/j.1553-2712.2008.00206.x

Cited by 56 publications

(31 citation statements)

References 20 publications

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“…7 A prospective study of traumatic brain injuries found high agreement for injury mechanism and history of loss of consciousness and moderate agreement for altered mental status. 8 A prospective study of blunt abdominal trauma found almost perfect agreement for injury mechanism and moderate agreement for painful injury, difficulty breathing, and tenderness. 9 A study of adults with dystonia showed moderate agreement (j = 0.52) for cervical dystonia.…”

Section: Discussionmentioning

confidence: 99%

Interobserver Agreement in Retrospective Chart Reviews for Factors Associated With Cervical Spine Injuries in Children

Olsen

Kuppermann

Jaffe

et al. 2015

Academic Emergency Medicine

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Objectives: The objective was to describe the interobserver agreement between trained chart reviewers and physician reviewers in a multicenter retrospective chart review study of children with cervical spine injuries (CSIs).Methods: Medical records of children younger than 16 years old with cervical spine radiography from 17 Pediatric Emergency Care Applied Research Network (PECARN) hospitals from years 2000 through 2004 were abstracted by trained reviewers for a study aimed to identify predictors of CSIs in children. Independent physician-reviewers abstracted patient history and clinical findings from a random sample of study patient medical records at each hospital. Interobserver agreement was assessed using percent agreement and the weighted kappa (j) statistic, with lower 95% confidence intervals.Results: Moderate or better agreement (j > 0.4) was achieved for most candidate CSI predictors, including altered mental status (j = 0.87); focal neurologic findings (j = 0.74); posterior midline neck tenderness (j = 0.74); any neck tenderness (j = 0.89); torticollis (j = 0.79); complaint of neck pain (j = 0.83); history of loss of consciousness (j = 0.89); nonambulatory status (j = 0.74); and substantial injuries to the head (j = 0.50), torso/trunk (j = 0.48), and extremities (j = 0.59). High-risk mechanisms showed near-perfect agreement (diving, j = 1.0; struck by car, j = 0.93; other motorized vehicle crash, j = 0.93; fall, j = 0.92; high-risk motor vehicle collision, j = 0.89; hanging, j = 0.80). Fair agreement was found for clotheslining mechanisms (j = 0.36) and substantial face injuries (j = 0.40).Conclusions: Most retrospectively assessed variables thought to be predictive of CSIs in blunt traumainjured children had at least moderate interobserver agreement, suggesting that these data are sufficiently valid for use in identifying potential predictors of CSI.ACADEMIC EMERGENCY MEDICINE 2015;22:487-491

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Section: Discussionmentioning

confidence: 99%

Interobserver Agreement in Retrospective Chart Reviews for Factors Associated With Cervical Spine Injuries in Children

Olsen

Kuppermann

Jaffe

et al. 2015

Academic Emergency Medicine

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“…Two clinicians independently evaluated a convenience sample of 4% of patients to assess interobserver agreement of clinical findings. 8 …”

Section: Patient Assessment and Variable Definitionsmentioning

confidence: 99%

Headache in Traumatic Brain Injuries From Blunt Head Trauma

Dayan

Holmes²,

Hoyle

et al. 2015

Pediatrics

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OBJECTIVE: To determine the risk of traumatic brain injuries (TBIs) in children with headaches after minor blunt head trauma, particularly when the headaches occur without other findings suggestive of TBIs (ie, isolated headaches).METHODS: This was a secondary analysis of a prospective observational study of children 2 to 18 years with minor blunt head trauma (ie, Glasgow Coma Scale scores of 14-15). Clinicians assessed the history and characteristics of headaches at the time of initial evaluation, and documented findings onto case report forms. Our outcome measures were (1) clinically important TBI (ciTBI) and (2) TBI visible on computed tomography (CT). RESULTS:Of 27 495 eligible patients, 12 675 (46.1%) had headaches. Of the 12 567 patients who had complete data, 2462 (19.6%) had isolated headaches. ciTBIs occurred in 0 of 2462 patients (0%; 95% confidence interval [CI]: 0%-0.1%) in the isolated headache group versus 162 of 10 105 patients (1.6%; 95% CI: 1.4%-1.9%) in the nonisolated headache group (risk difference, 1.6%; 95% CI: 1.3%-1.9%). TBIs on CT occurred in 3 of 456 patients (0.7%; 95% CI: 0.1%-1.9%) in the isolated headache group versus 271 of 6089 patients (4.5%; 95% CI: 3.9%-5.0%) in the nonisolated headache group (risk difference, 3.8%; 95% CI: 2.3%-4.5%). We found no significant independent associations between the risk of ciTBI or TBI on CT with either headache severity or location.CONCLUSIONS: ciTBIs are rare and TBIs on CT are very uncommon in children with minor blunt head trauma when headaches are their only sign or symptom. WHAT'S KNOWN ON THIS SUBJECT:Although headache is a common symptom after minor blunt head trauma in children, controversy exists whether the presence of headache increases the risk of traumatic brain injury. WHAT THIS STUDY ADDS:Clinically important traumatic brain injuries are rare, and traumatic brain injuries on computed tomography are very uncommon in children with minor blunt head trauma when headaches are their only sign or symptom. Dr Dayan conceived of and designed the study, including the data collection instruments, supervised the conduct of the study and data collection at his center, and drafted the initial manuscript; Dr Kuppermann conceived of and designed the study, including the data collection instruments, supervised the conduct of the study and data collection at his center, obtained research funding, and critically reviewed the manuscript; Drs Holmes, Atabaki, Hoyle Jr, Tunik, and Lichenstein supervised the conduct of the study and data collection at their sites and critically reviewed the manuscript; Ms Miskin managed the data, including quality control, conducted all analyses, and reviewed and revised the manuscript; and all authors approved the final manuscript as submitted. Computed tomography (CT) scans must be used judiciously in children with minor head trauma, balancing the need to identify important injuries with the risks of radiation-induced malignancy. 4,5 Children with minor blunt head trauma frequently present to the ED with histo...

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“…1 Recent investigators in the pediatric ED have measured MD-MD interrater agreement for potential predictors in a variety of conditions. 9,14,15 Across these studies, the agreement beyond chance is often only fair to moderate, particularly for physical examination findings.…”

Section: Discussionmentioning

confidence: 99%

“…9,14,15 In our study, we measured the agreement between the ED RN and MD in the assessment of the predictors included in the published PECARN TBI prediction rules. Similar to previous work measuring the RN-MD agreement in the evaluation of the Ottawa ankle rules in adult ED patients, [5][6][7] we found fair to moderate agreement between RN and MD evaluation of the validated prediction rule.…”

Section: Discussionmentioning

confidence: 99%

“…8 The predictors included these rules were assessed by the attending MD and selected from variables that had at least moderate MD-MD interrater reliability. 9 However, the ED RN is typically the first health care provider to evaluate a child with minor blunt head trauma. Application of the PECARN TBI prediction models soon after patient arrival may increase the clinical impact of these prediction rules by improving initial resource allocation (eg, children with minor blunt head trauma at low risk for clinically important TBI might be triaged to a fast-track area, whereas children at higher risk could be more rapidly assessed in an acute-care area of the ED).…”

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Nurse and Physician Agreement in the Assessment of Minor Blunt Head Trauma

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Effective implementation of Pediatric Emergency Care Applied Research Network head trauma rules depends on their early application. As the registered nurse (RN) is often the first to evaluate children with blunt head trauma, initial RN assessments will be an important component of this strategy. WHAT THIS STUDY ADDS:We demonstrated fair to moderate agreement between RN and physician providers in the application of the Pediatric Emergency Care Applied Research Network head trauma rules. Effective implementation strategies may require physician verification of RN predictor assessments before computed tomography decision-making. abstract OBJECTIVE: The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) clinical prediction rules identify children with minor blunt head trauma who are at low risk for clinically important traumatic brain injuries. We measured the agreement between the registered nurse (RN) and physician (MD) assessments. METHODS:We performed a cross-sectional study of all children ,18 years of age with minor blunt head trauma who presented to a single emergency department. RNs and MDs independently assessed each child and recorded age-based PECARN predictors. As symptoms can change over time, we included cases only when both evaluations were completed within 60 minutes. We used the k statistic to measure RN-MD agreement, with the main analysis focusing on the overall PECARN rule agreement. RESULTS:Of the 1624 eligible children, 1191 (73%) had evaluations completed by both RN and ED providers, of which 437 (37%) were in children ,2 years of age. The median time between completions of the provider forms was 12 minutes (interquartile range 4-25 minutes). The overall agreement between the RN and MD was higher for the older children (k 0.55, 95% confidence interval 0.49-0.61 for children 2-18 years versus k 0.32, 95% confidence interval 0.23-0.41 for children ,2 years). CONCLUSIONS:The overall agreement between RN and MD for the PECARN TBI prediction rules was moderate for older children and fair for younger children. Initial RN assessments should be verified by the MD before clinical application, especially for the youngest children. Pediatrics 2013;132:e689-e694

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Interobserver Agreement in Assessment of Clinical Variables in Children with Blunt Head Trauma

Cited by 56 publications

References 20 publications

Interobserver Agreement in Retrospective Chart Reviews for Factors Associated With Cervical Spine Injuries in Children

Interobserver Agreement in Retrospective Chart Reviews for Factors Associated With Cervical Spine Injuries in Children

Headache in Traumatic Brain Injuries From Blunt Head Trauma

Nurse and Physician Agreement in the Assessment of Minor Blunt Head Trauma

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