Interrater agreement in the clinical evaluation of acute pediatric XXXX .

@entity1 @entity565 @entity341 @entity1353
Prior studies of observer agreement of the clinical exam of @entity1 with @entity565 have focused on small numbers of specially trained observers, often in the setting of clinical trials. Our objective was to evaluate interobserver reliability in the physical exam of acute pediatric wheezing and @entity565 among a large group of diverse examiners, in a setting of routine clinical practice, and without prior special training. The setting was a large urban @entity1 's hospital. Observers were attending pediatric emergency physicians and fellows; hospital respiratory therapists; and @entity341 ( @entity341 ) nurses. @entity1 were @entity1 receiving nebulized medications for wheezing in the @entity341 or inpatient @entity565 unit. Pairs of observers simultaneously but independently rated work of breathing, wheeze, decreased air entry, prolonged expiration, @entity1353 , respiratory rate, mental status, and global (or overall) severity using a structured exam template. A total score for each exam was also evaluated. A total of 230 pairs of observations were performed; mean @entity1 age was 5.3 years. For all pairs, the weighted kappa statistics for the exam components ranged from 0.61 to 0.74 (moderate or substantial agreement). The global severity category and total score had weighted kappas of 0.80 and 0.82, respectively (excellent agreement). Agreement was generally somewhat lower for unlike (different profession) observer pairs than for like observer pairs, but remained acceptable. Agreement in two age groups (< or = 3 years old and > or = 4) was at least moderate for all exam components analyzed. Spearman rank correlations between individual exam components and the global assessments of @entity1 severity were all greater than 0.5, indicating at least moderate to good correlations. We found substantial interobserver agreement among a broad range of examiners in the components of the clinical examination of acute wheezing in both younger and older @entity1 . This is contrary to the commonly held observation that the poor interobserver reliability of physical exam findings in @entity565 may limit their usefulness as @entity565 outcome measures. Support for use of a structured respiratory exam format or template in @entity565 guidelines was also shown.
