Vegt, M. van der (Marieke) (2014) Inter-Observer Agreement in Clinical Assessment of Children with Acute Dyspnea in the Emergency Department. thesis, Medicine.
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Abstract
Background: A large number of clinical dyspnea scores have been developed to reduce the substantial variation between providers in assessing the severity of dyspnea. However, the aspect of inter-observer agreement of these scoring systems has rarely been studied. Objective: To prospectively determine the inter-observer agreement of common clinical findings in children aged 0 to 16 years presenting with acute dyspnea to the emergency department of a large general teaching hospital by comparing live assessments with video assessments. Methods: Two observers examined each patient independently and assessed severity of dyspnea by scoring respiratory rate, retractions, prolonged expirium, nasal flaring, mental status and a general assessment of dyspnea on a Likert scale (1-10). After clinical examination, children were recorded on video with breath sounds recorded simultaneously. These video recordings were independently assessed by 2 pediatric pulmonologists by scoring the same items. Results: Thirty-six patients were enrolled, six of whom were analyzed separately because the overall assessment of dyspnea was considered low by both observers. The inter-observer agreement for live assessments was fair to good (kappa 0.23-0.81), and agreement for video assessments was considerably worse (kappa 0.05-0.32). No significant difference was found between the overall assessments of the experienced observer compared to the less experienced observer. Conclusions: Inter-observer agreement was poor for individual clinical findings, and modest for the overall assessment of severity of dyspnea. Live assessments showed higher agreement than video assessments. When studying the inter-observer agreement of clinical findings in children with dyspnea, live assessments are preferred over videotaped assessments. More research is needed focusing on factors which may reduce variation between observers. It is unlikely that this is largely explained by experience of the observer.
| Item Type: | Thesis (Thesis) |
|---|---|
| Supervisor name: | Brand, Prof. Dr. P.L.P. and Isala, Zwolle |
| Faculty: | Medical Sciences |
| Date Deposited: | 25 Jun 2020 10:48 |
| Last Modified: | 25 Jun 2020 10:48 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/967 |
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