Laboratory of Clinical Epidemiology, Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Av Brasil, 4365-Manguinhos, Rio de Janeiro, RJ, Brazil.
Infection. 2011 Apr;39(2):135-40. doi: 10.1007/s15010-011-0101-0. Epub 2011 Apr 13.
To assess the interobserver agreement on clinical history and physical examination when using a semi-structured questionnaire to evaluate patients with an acute febrile illness (AFI).
A cross-sectional study was conducted with outpatients aged 12 years and over, presenting with an AFI defined as fever up to 7 days and no evident focus of infection. Clinical data were collected independently by two physicians using a semi-structured questionnaire. Interobserver agreement was estimated using kappa coefficients with a 95% confidence interval (CI).
A total of 140 patients (age range 13-73 years; 56.4% females) were enrolled. All symptoms showed weighted kappa values significantly greater than 0.6, indicating an at least substantial agreement. As most physical signs were infrequent and of mild intensity, they were recoded and analyzed as absent/present. Of the signs with prevalence ≥15%, exanthema, pallor, lymph node enlargement, and eye congestion showed agreements significantly greater than 0.6, while kappa confidence limits for pharyngeal erythema and dehydration included values classified as regular.
High agreement was observed for most of the clinical data assessed, and symptom grading was feasible. Some physical findings were rare and their inclusion in a structured form may not be justified in this setting. The questionnaire application showed good reliability for the most frequent signs and symptoms and may prove to be useful at gathering data for surveillance and research at sentinel sites.
评估使用半结构化问卷评估急性发热性疾病（AFI）患者时的临床病史和体格检查的观察者间一致性。
这是一项横断面研究，纳入了年龄在 12 岁及以上、出现发热持续时间不超过 7 天且无明显感染灶的 AFI 的门诊患者。两名医生使用半结构化问卷独立采集临床数据。使用 95%置信区间（CI）的kappa 系数来评估观察者间的一致性。
共纳入了 140 例患者（年龄 13-73 岁；56.4%为女性）。所有症状的加权 kappa 值均显著大于 0.6，表明存在至少是中等程度的一致性。由于大多数体征较为少见且强度较轻，因此对其进行了重新编码并以存在/缺失进行分析。在患病率≥15%的体征中，出疹、苍白、淋巴结肿大和眼球充血的一致性显著大于 0.6，而红斑和脱水的咽峡部 kappa 置信区间值包括了分类为规则的数值。
评估的大多数临床数据的观察者间一致性较高，并且症状分级是可行的。一些体格检查发现较为罕见，在这种情况下，将其纳入结构化表格可能并不合理。该问卷的应用对于最常见的体征和症状具有良好的可靠性，可能有助于在哨点收集监测和研究数据。
