TY - JOUR
T1 - Interexaminer reliability in physical examination of pediatric patients with abdominal pain
AU - Yen, Kenneth
AU - Karpas, Anna
AU - Pinkerton, Heidi J.
AU - Gorelick, Marc H.
N1 - Copyright:
Copyright 2008 Elsevier B.V., All rights reserved.
PY - 2005/4
Y1 - 2005/4
N2 - Objective: To test the interexaminer reliability of abdominal examinations performed by pediatric emergency medicine physicians and surgeons in an emergency department. Methods: A prospective cross-sectional study in which 3 different types of physicians (pediatric emergency department residents, pediatric emergency department attending physicians, and pediatric surgeons in training) independently examined a convenience sample of children (aged 3-19 years) with initial complaint of abdominal pain. The interexaminer reliability of 6 components of the abdominal examination (the presence or absence of abdominal distension, abdominal tenderness to percussion, abdominal tenderness to palpation, abdominal guarding, rebound tenderness, and bowel sounds) and the clinical diagnosis of peritonitis was tested. Results: Sixty-eight patients were examined by pediatric emergency department residents and pediatric emergency department attending physicians. All 3 physician types examined 46 of these 68 patients. When comparing residents and attending physicians, the components of the abdominal examination showed less than moderate chance-adjusted agreement (κ range, -0.04 to 0.38). When comparing attending physicians and surgeons, the presence of rebound tenderness showed moderate agreement (κ = 0.54). The rest of the components demonstrated less than moderate chance-adjusted agreement (κ range, -0.04 to 0.34). Conclusions: The components of the abdominal examination are poorly reliable between physician types. Only the "rebound tenderness" component of the abdominal examination shows moderate agreement between the pediatric emergency department attending physicians and the surgeon. No component of the abdominal examination appears to be consistently reliable. Interexaminer agreement must be considered when developing management strategies for acute abdomen. Interventions to improve reliability should be developed.
AB - Objective: To test the interexaminer reliability of abdominal examinations performed by pediatric emergency medicine physicians and surgeons in an emergency department. Methods: A prospective cross-sectional study in which 3 different types of physicians (pediatric emergency department residents, pediatric emergency department attending physicians, and pediatric surgeons in training) independently examined a convenience sample of children (aged 3-19 years) with initial complaint of abdominal pain. The interexaminer reliability of 6 components of the abdominal examination (the presence or absence of abdominal distension, abdominal tenderness to percussion, abdominal tenderness to palpation, abdominal guarding, rebound tenderness, and bowel sounds) and the clinical diagnosis of peritonitis was tested. Results: Sixty-eight patients were examined by pediatric emergency department residents and pediatric emergency department attending physicians. All 3 physician types examined 46 of these 68 patients. When comparing residents and attending physicians, the components of the abdominal examination showed less than moderate chance-adjusted agreement (κ range, -0.04 to 0.38). When comparing attending physicians and surgeons, the presence of rebound tenderness showed moderate agreement (κ = 0.54). The rest of the components demonstrated less than moderate chance-adjusted agreement (κ range, -0.04 to 0.34). Conclusions: The components of the abdominal examination are poorly reliable between physician types. Only the "rebound tenderness" component of the abdominal examination shows moderate agreement between the pediatric emergency department attending physicians and the surgeon. No component of the abdominal examination appears to be consistently reliable. Interexaminer agreement must be considered when developing management strategies for acute abdomen. Interventions to improve reliability should be developed.
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U2 - 10.1001/archpedi.159.4.373
DO - 10.1001/archpedi.159.4.373
M3 - Article
C2 - 15809393
AN - SCOPUS:16844364387
SN - 1072-4710
VL - 159
SP - 373
EP - 376
JO - Archives of Pediatrics and Adolescent Medicine
JF - Archives of Pediatrics and Adolescent Medicine
IS - 4
ER -