Interobserver Agreement in the Assessment of Clinical Findings in Children With First Unprovoked Seizures

Dayan, Peter; Lillis, Kathleen; Bennett, Jonathan E.; Conners, Gregory P.; Bailey, P.W.; Callahan, James M.; Akman, Cidgem; Feldstein, Neil A.; Hauser, W. Allen; Kuppermann, Nathan

doi:10.1542/peds.2010-1752

Cited by 16 publications

(10 citation statements)

References 12 publications

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“…Like these studies, we were also able to identify numerous historical and physical examination variables with good clinical plausibility and adequate interobserver agreement. Unlike our study, the study to identify candidate variables for children with first‐time seizures had many physical examination variables that were infrequently present and had relatively low κ values . A low κ value can be an artifact of a low prevalence for a particular clinical finding, despite high raw agreement .…”

Section: Discussionmentioning

confidence: 82%

“…Our study is similar to two multicenter pediatric studies conducted as part of the development of separate clinical predication rules for traumatic brain injury and seizures. One group of investigators evaluated the interobserver agreement of historical and physical examination finding in pediatric blunt head trauma, while another group evaluated those in children with first unprovoked seizures . Like these studies, we were also able to identify numerous historical and physical examination variables with good clinical plausibility and adequate interobserver agreement.…”

Section: Discussionmentioning

confidence: 87%

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Interobserver Agreement in the Clinical Assessment of Children With Blunt Abdominal Trauma

Yen

Kuppermann

Lillis

et al. 2013

Academic Emergency Medicine

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Objectives The objective was to determine the interobserver agreement of historical and physical examination findings assessed during the emergency department (ED) evaluation of children with blunt abdominal trauma. Methods This was a planned substudy of a multicenter, prospective cohort study of children younger than 18 years of age evaluated for blunt abdominal trauma. Patients were excluded if injury occurred more than 24 hours prior to evaluation or if computed tomography (CT) imaging was obtained at another hospital prior to transfer to a study site. Two clinicians independently recorded their clinical assessments of a convenience sample of patients onto data collection forms within 60 minutes of each other and prior to CT imaging (if obtained) or knowledge of laboratory results. The authors categorized variables as either subjective symptoms (i.e., patient history) or objective findings (i.e., physical examination). For each variable recorded by the two observers, the agreement beyond that expected by chance was estimated, using the kappa (κ) statistic for categorical variables and weighted κ for ordinal variables. Variables with 95% lower confidence limits (LCLs) κ ≥ 0.4 (moderate agreement or better) were considered to have acceptable agreement. Results A total of 632 pairs of physician observations were obtained on 23 candidate variables. Acceptable agreement was achieved in 16 (70%) of the 23 variables tested. For six subjective symptoms, κ ranged from 0.48 (complaint of shortness of breath) to 0.90 (mechanism of injury), and only the complaint of shortness of breath had a 95% LCL κ < 0.4. For the 17 objective findings, κ ranged from –0.01 (pelvis instability) to 0.82 (seat belt sign present). The 95% LCL for κ was <0.4 for flank tenderness, abnormal chest auscultation, suspicion of alcohol or drug intoxication, pelvis instability, absence of bowel sounds, and peritoneal irritation. Conclusions Observers can achieve at least acceptable agreement on the majority of historical and physical examination variables in children with blunt abdominal trauma evaluated in the ED. Those variables are candidates for consideration for development of a clinical prediction rule for intra‐abdominal injury in children with blunt trauma.

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Section: Discussionmentioning

confidence: 82%

Section: Discussionmentioning

confidence: 87%

Interobserver Agreement in the Clinical Assessment of Children With Blunt Abdominal Trauma

Yen

Kuppermann

Lillis

et al. 2013

Academic Emergency Medicine

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“…Pediatric seizures are a common problem. A large proportion of all pediatric seizures occur among children younger than 2 years of age 1,2 where seizures tend to be of shorter duration and in more than 50% have focal features. [3][4][5][6] Previous literature suggests that nearly half of children presenting with seizure having focal manifestations will have abnormal neuroimaging.…”

Section: Introductionmentioning

confidence: 99%

Pediatric first time non-febrile seizure with focal manifestations: Is emergent imaging indicated?

Aprahamian¹,

Harper²,

Prabhu³

et al. 2014

Seizure

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“…We do not believe that the retrospective validation introduced important biases since the predictors are objective. Four of the five factors are laboratory values and one clinical factor (seizure at or prior to the time of initial presentation), should be reliably recorded in the medical records 32 33…”

Section: Discussionmentioning

confidence: 99%

Meta-analysis of bacterial meningitis score validation studies

2012

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Interobserver Agreement in the Assessment of Clinical Findings in Children With First Unprovoked Seizures

Cited by 16 publications

References 12 publications

Interobserver Agreement in the Clinical Assessment of Children With Blunt Abdominal Trauma

Interobserver Agreement in the Clinical Assessment of Children With Blunt Abdominal Trauma

Pediatric first time non-febrile seizure with focal manifestations: Is emergent imaging indicated?

Meta-analysis of bacterial meningitis score validation studies

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