The inter-observer agreement of examining pre-school children with acute cough: a nested study.

Alastair D Hay,Andrew Wilson,Tom Fahey,Tim J Peters

doi:10.1186/1471-2296-5-4

Abstract

BackgroundThe presence of clinical signs have implications for diagnosis, prognosis and treatment. Therefore, the aim of this study was to examine the inter-observer agreement of clinical signs in pre-school children presenting to primary care.MethodsA nested study comparing two clinical assessments within a prospective cohort of 256 pre-school children with acute cough recruited from eight general practices in Leicestershire, UK. We examined agreement (using kappa statistics) between unstandardised and standardised clinical assessments of tachypnoea, chest signs and fever.ResultsKappa values were poor or fair for all clinical signs (range 0.12 to 0.39) with chest signs the most reliable.ConclusionsPrimary care clinicians should be aware that clinical signs may be unreliable when making diagnosis, prognosis and treatment decisions in pre-school children with cough. Future research should aim to further our understanding of how best to identify abnormal clinical signs.

Highlights

The presence of clinical signs have implications for diagnosis, prognosis and treatment
The absence of tachypnoea has been shown to be most useful for ruling out pneumonia[3], and fever is associated with poor outcome in children with cough[4] and otitis media[5]
Sixty-one General Practitioner (GP) and three Nurse Practitioner (NP) performed the role of observer one, and 96% of children were seen by a GP

Summary

Introduction

The presence of clinical signs have implications for diagnosis, prognosis and treatment. The aim of this study was to examine the inter-observer agreement of clinical signs in pre-school children presenting to primary care. The presence of clinical signs may have diagnostic, prognostic, and treatment implications. Prognostic and treatment implications of these clinical signs, we decided to examine the inter-observer agreement between a standardised and non-standardised clinical assessment in pre-school children presenting with acute cough in primary care. These were children already recruited to a cohort study investigating duration and complications of cough[4,10]

Objectives

Methods

Results

Discussion

Conclusion