Walsh Paul, Gonzales Adrian, Satar Amina, Rothenberg Stephen J
Department of Emergency Medicine, Kern Medical Center, Bakersfield, CA 93305, USA.
Pediatr Emerg Care. 2006 May;22(5):316-20. doi: 10.1097/01.pec.0000215136.44286.8f.
We previously constructed and tested a bronchiolitis severity assessment tool in 2 independent hospitals. The model uses age, work of breathing, dehydration and tachycardia to successfully predict disease severity.
To prospectively measure the interrater reliability of a bronchiolitis severity assessment tool and of its component variables.
Prospective observational survey.
A county teaching hospital emergency department serving a mixed urban and rural population with an emergency medicine residency program in 2-3-4 format.
Thirty-two physicians evaluated a convenience sample of children aged less than 18 months presenting to the emergency department with a clinical diagnosis of bronchiolitis during a single season.
Two physicians independently examined each patient. Each physician completed a physical examination template that included the variables used in the severity assessment tool. Interrater agreement was measured for the variables work of breathing and dehydration and for the tool as a whole using a weighted kappa statistic.
One hundred and forty-six cases were enrolled. Twenty-five were dropped for incomplete data collection. The actual weighted agreement on overall classification was 92%; expected, 73%, kappa = 0.676; P < 0.0001. The actual weighted agreement for dehydration was at 95%; expected, 92%, kappa = 0.305; P = 0.0001. The agreement for work of breathing was 95%; expected, 86%; kappa = 0.611; P < 0.0001. The overall model showed better interrater reliability than its individual components.
Overall interrater reliability for this bronchiolitis severity assessment tool is substantial.
我们之前在两家独立医院构建并测试了一种细支气管炎严重程度评估工具。该模型使用年龄、呼吸做功、脱水和心动过速来成功预测疾病严重程度。
前瞻性地评估细支气管炎严重程度评估工具及其组成变量的评分者间信度。
前瞻性观察性调查。
一家县教学医院急诊科，服务于城乡混合人口，有一个采用2 - 3 - 4模式的急诊医学住院医师培训项目。
32名医生对在单个季节因临床诊断为细支气管炎而到急诊科就诊的18个月以下儿童的便利样本进行了评估。
两名医生独立检查每位患者。每位医生完成一份体格检查模板，其中包括严重程度评估工具中使用的变量。使用加权kappa统计量测量呼吸做功和脱水变量以及整个工具的评分者间一致性。
共纳入146例病例。25例因数据收集不完整而被剔除。总体分类的实际加权一致性为92%；预期一致性为73%，kappa = 0.676；P < 0.0001。脱水的实际加权一致性为95%；预期一致性为92%，kappa = 0.305；P = 0.0001。呼吸做功的一致性为95%；预期一致性为86%；kappa = 0.611；P < 0.0001。总体模型显示出比其各个组成部分更好的评分者间信度。
该细支气管炎严重程度评估工具的总体评分者间信度较高。
