Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.
Universidade Estácio de Sá, Rio de Janeiro, Brazil.
J Clin Nurs. 2020 May;29(9-10):1590-1598. doi: 10.1111/jocn.15229. Epub 2020 Mar 10.
To compare and evaluate interobserver (nurses and physicians) agreement for dengue clinical signs and symptoms, including the World Health Organization diagnostic algorithm.
Agreement of clinical history defines the capacity of the examiner to measure a given clinical parameter in a reproducible and consistent manner, which is prerequisite for diagnosis validity. Nurses play a major role in the triage and care of dengue patients in many countries.
This is a sub-study on interobserver agreement performed as part of a cross-sectional diagnostic accuracy study for acute febrile illness (AFI) using the checklist STARD.
A previously validated semi-structured sign and symptom standardised questionnaire for AFI was independently administered to 374 patients by physician and nurse pairs. The interobserver agreement was estimated using kappa statistics.
For a set of 27 signs and symptoms, we found six interobserver discrepancies (examiner detected red eyes, lethargy, exanthema, dyspnoea, bleeding and myalgia) as identified by regular and moderate kappa indexes. Four signs (patient observed red eyes, cough, diarrhoea and vomiting) and one symptom (earache) had near-perfect agreement. Most signs and symptoms showed substantial agreement. The WHO (Dengue guidelines for diagnosis, treatment, prevention and control: new edition, World Health Organization, 2009) clinical criteria for dengue comprise a group of symptoms known as "pains and aches." Interobserver agreement for abdominal pain, retro-orbital pain and arthralgia exceed that found for headache and myalgia.
During a dengue outbreak, the interobserver agreement for most of the signs and symptoms used to assess AFI was substantial.
This result suggests good potential applicability of the tool by health professionals following training. A well-trained health professional is qualified to apply the standardised questionnaire to evaluate suspected dengue cases during outbreaks.
比较和评估观察者（护士和医生）对登革热临床体征和症状的一致性，包括世界卫生组织的诊断算法。
临床病史的一致性定义了检查者以可重复和一致的方式测量给定临床参数的能力，这是诊断有效性的前提。在许多国家，护士在登革热患者的分诊和护理中发挥着重要作用。
这是一项观察者间一致性的亚研究，作为使用 STARD 清单进行急性发热性疾病（AFI）横断面诊断准确性研究的一部分。
使用之前验证过的用于 AFI 的半结构化体征和症状标准化问卷，由医生和护士对 374 名患者进行独立评估。使用kappa 统计量估计观察者间一致性。
对于一组 27 个体征和症状，我们发现了六个观察者间差异（检查者发现眼红、嗜睡、出疹、呼吸困难、出血和肌痛），其kappa 指数为常规和中度。四个体征（患者观察到眼红、咳嗽、腹泻和呕吐）和一个症状（耳痛）具有近乎完美的一致性。大多数体征和症状具有实质性的一致性。世界卫生组织（登革热诊断、治疗、预防和控制指南：新版本，世界卫生组织，2009 年）的登革热临床标准包括一组称为“疼痛”的症状。对腹痛、眼眶后疼痛和关节痛的观察者间一致性超过对头痛和肌痛的一致性。
在登革热疫情期间，用于评估 AFI 的大多数体征和症状的观察者间一致性是实质性的。
经过培训，该工具的大多数体征和症状具有良好的潜在适用性。经过良好培训的卫生专业人员有资格在疫情期间应用标准化问卷评估疑似登革热病例。
