Intervention to improve interobserver agreement in the assessment of children with pharyngitis. Pediatr Emerg Care 2005 Apr;21(4):238-41
Date
04/13/2005Pubmed ID
15824682Scopus ID
2-s2.0-17644383702 (requires institutional sign-in at Scopus site) 3 CitationsAbstract
OBJECTIVE: The objective of this study is to examine the effectiveness of an intervention to improve interobserver reliability of clinical evaluation of children with pharyngitis.
METHODS: This was a sequential trial performed in an academic children's hospital emergency department. Two sets of 100 children aged 2 to 18 years with a complaint of sore throat were independently evaluated by emergency department attending staff and residents for coryza, scarlatiniform rash, tonsillar enlargement, tonsillar erythema, tonsillar exudates, cervical adenopathy, and palatal petechiae. The first 100 subjects were evaluated according to the clinician's routine practice; the second set was evaluated using a visual-aid sheet showing pictorial gradations of each characteristic. All findings were scored dichotomously and analyzed by kappa statistics.
RESULTS: Both sets of patients were similar with respect to age, sex, race, and prior episodes of group A beta-hemolytic streptococcus. Interobserver reliability without the visual aid was poor in all areas except tonsillar enlargement and tonsillar exudates which had kappa values of 0.50 and 0.58, respectively. The use of the visual-aid sheet did not significantly improve reliability in any of the clinical evaluations, and all kappa scores remained below 0.50.
CONCLUSION: Interobserver reliability in evaluating clinical signs of pharyngitis is fair to poor. The use of pictorial prompts does not improve interobserver reliability.
Author List
Jensen DM, Brousseau DC, Tumpach EA, Gorelick MHMESH terms used to index this publication - Major topics in bold
AdolescentAudiovisual Aids
Child
Child, Preschool
Decision Support Techniques
Diagnosis, Differential
Emergency Medicine
Female
Humans
Male
Observer Variation
Pediatrics
Pharyngitis
Practice Patterns, Physicians'
Prospective Studies
