Kappa Coefficient For Inter-rater Reliability Research Articles

Adaptation and Validation of the Standardized Swallowing Assessment Tool for Patients With Moderate-Severe Traumatic Brain Injury and Cervical Spinal Cord Injury.

Oropharyngeal dysphagia is common in moderate-severe traumatic brain injury (TBI) and cervical spinal cord injury (SCI) patients and can have serious consequences. Delaying feeding in these patients can also be detrimental. Nonetheless, the psychometric properties of screening tools that can promptly identify dysphagia have never been tested in these neurotrauma populations. This study aimed to: (1) adapt, translate, and validate the content of the French-Canadian version of the the Standardized Swallowing Assessment (SSA) tool to meet the needs of moderate-severe TBI and cervical SCI patients, (2) examine its inter-rater reliability and criterion-concurrent validation, and (3) evaluate its clinical utility from the perspectives of critical care nurses. The SSA tool was adapted and translated using an integrated method for the cultural adaptation and translation of tools. Eleven experts participated in the adaptation of the SSA tool, which led to the clarification of one item, as well as a new step and instructions for the screening procedure. Content validation (i.e., item and scale relevance) was evaluated by multidisciplinary team members (n = 17). The mean content validity index (CVI) score was 0.97 for the entire scale, while the mean CVI scores for individual items ranged from 0.82 to 1.0. A total of 60 neurotrauma patients were enrolled for inter-rater reliability and criterion-concurrent validation. Interrater reliability was determined by comparing two scores: one score from nurses responsible for the care of enrolled patients and one score from the research nurse. The weighted kappa coefficients for inter-rater reliability were 0.86 for moderate-severe TBI patients (n = 30) and 0.73 for cervical SCI patients (n = 30). A speech language therapist (SLT) also assessed dysphagia and results were used as the standard clinical reference criterion to determine concurrent validity (sensibility and specificity) of the adapted SSA tool. The sensitivity and specificity were 92% and 50% for moderate-severe TBI, and 77% and 75% for cervical SCI, respectively. The positive predictive value (PPV) and the negative predictive value (NPV) were 65% and 87% in TBI patients, and 75% and 76% in SCI patients. Test accuracy was 71% and 77% for these same groups. The clinical utility of the tool was evaluated according to the following domains: appropriateness, accessibility of the required material, applicability, perceived effectiveness, and acceptability. Acceptability was the only domain with a level of agreement <80% (74%) among trauma critical care nurses (n = 49). Findings support the content validation and inter-rater reliability of the adapted French-Canadian version of the SSA tool in moderate-severe TBI and cervical SCI patients. Sensitivity was acceptable in both groups, but the specificity was lower, especially in moderate-severe TBI patients. Further validation of the adapted French-Canadian version of the SSA tool is needed in neurotrauma patients to confirm these results and to ensure safe dysphagia screening while avoiding oral feeding deferrals.

Six-Lead Electrocardiography Enables Identification of Rhythm and Conduction Anomalies of Patients in the Telemedicine-Based, Hospital-at-Home Setting: A Prospective Validation Study.

The hospital-at-home (HAH) model is a viable alternative for conventional in-hospital stays worldwide. Serum electrolyte abnormalities are common in acute patients, especially in those with many comorbidities. Pathologic changes in cardiac electrophysiology pose a potential risk during HAH stays. Periodical electrocardiogram (ECG) tracing is therefore advised, but few studies have evaluated the accuracy and efficiency of compact, self-activated ECG devices in HAH settings. This study aimed to evaluate the reliability of such a device in comparison with a standard 12-lead ECG. We prospectively recruited consecutive patients admitted to the Sheba Beyond Virtual Hospital, in the HAH department, during a 3-month duration. Each patient underwent a 12-lead ECG recording using the legacy device and a consecutive recording by a compact six-lead device. Baseline patient characteristics during hospitalization were collected. The level of agreement between devices was measured by Cohen's kappa coefficient for inter-rater reliability (Ϗ). Fifty patients were included in the study (median age 80 years, IQR 14). In total, 26 (52%) had electrolyte disturbances. Abnormal D-dimer values were observed in 33 (66%) patients, and 12 (24%) patients had elevated troponin values. We found a level of 94.5% raw agreement between devices with regards to nine of the options included in the automatic read-out of the legacy device. The calculated Ϗ was 0.72, classified as a substantial consensus. The rate of raw consensus regarding the ECG intervals' measurement (PR, RR, and QT) was 78.5%, and the calculated Ϗ was 0.42, corresponding to a moderate level of agreement. This is the first report to our knowledge regarding the feasibility of using a compact, six-lead ECG device in the setting of an HAH to be safe and bearing satisfying agreement level with a legacy, 12-lead ECG device, enabling quick, accessible arrythmia detection in this setting. Our findings bear a promise to the future development of telemedicine-based hospital-at-home methodology.

Evaluation of Lisfranc Injuries: How Involved is the First Tarsometatarsal Joint?

Category:Midfoot/Forefoot; TraumaIntroduction/Purpose:Lisfranc injuries are among the most debilitating injuries to the midfoot. Various classification systems have characterized the injury patterns with specific focus on the interval between the base of the second metatarsal and the medial cuneiform as well as the importance of the ligamentous structures of the midfoot. The medial ligamentous restraints of the first tarsometatarsal (TMT) joint and the bony involvement of these injuries remains unclear. Improved knowledge on how the first TMT joint is affected in Lisfranc injuries will provide information on how best to manage these injuries.Methods:We conducted a single institution review of all Lisfranc fractures from 2010 through 2020. Patients were identified by CPT codes. Hardcastle and Myerson Lisfranc injury classifications and computed tomography and radiograph characterizations of the first TMT joint were identified by three foot and ankle trained orthopaedic surgeons. Light's kappa statistics (mean weighted Cohen's kappa) evaluated inter-rater reliability of Lisfranc classifications. The effects injury mechanism and Lisfranc classification on the first TMT joint were further assessed using t-test, Mann-Whitney U, Fisher's exact test, and analysis of variance.Results:Of 71 patients with a Lisfranc injury, 62 (87%) had a sign of injury to the first TMT joint, which significantly varied by Lisfranc classification (P<0.001; Table). Light's kappa coefficient for inter-rater reliability was 0.46. A fragment of the first TMT articular surface was present in 39 patients (55%; median size=10mm) and a medial capsular avulsion fragment was seen in 28 patients (39%). A fracture was present in the medial cuneiform in 25 patients (35%) and in the first metatarsal in 18 patients (25%). Forty-nine patients (69%) had medial/lateral TMT joint incongruence (median overhang=4mm); 21 (30%) had dorsal/plantar incongruence (median overhang=6mm), which significantly differed by Lisfranc classification (P<0.02) and gender (Female=3.5mm; Male=7mm; P<0.03). Angulation of articular surfaces in the first TMT joint over 5 degrees on the transverse/antero-posterior plane occurred in 32 patients (45%) and in 12 patients (17%) on the sagittal/lateral plane, which significantly differed between Lisfranc classifications (P<0.03).Conclusion:Lisfranc injuries have great potential for long-term disability requiring careful screening and diagnosis. The overwhelming majority of Lisfranc injuries include damage to the first tarsometatarsal joint. This is the first study to our knowledge that characterizes this in detail. This study found that the most common patterns involving the first TMT joint included joint incongruity, capsular avulsion and articular surface fracture. A better understanding of injuries to the first TMT can help orthopaedic surgeons with diagnosis and management.

The development and application of a triage system for urolithiasis during COVID-19.

PurposeTo balance epidemic prevention with the therapeutic needs of patients with urolithiasis during the COVID-19 pandemic, we developed a triage system to guide medical staff in making priority decisions.MethodsThe study began with a review of the literature to propose a theoretical framework. Then, focus groups were assembled to develop, supplement, refine and form a consensus on the indications of the triage system. Finally, the system was implemented in the clinic. The validity and reliability of the system were tested by a content validity index and the interrater reliability kappa coefficient. Changes in patient characteristics and waiting time before and after the epidemic were compared.ResultsThe theoretical framework was based on disease pathophysiology, including obstruction, infection, kidney dysfunction, and other symptoms. With this guide, a 28-item triage system with categories of T1–5 (low priority to urgent) was developed. The content validity index and the interrater reliability coefficient were 0.833 and 0.812, respectively. During clinical application, although the total number of patients remained steady, the proportion of T1 decreased significantly; even though the overall waiting time of patients did not change significantly, it increased for T1 and decreased for T2–4 in 2020 compared with 2019 (P < 0.05).ConclusionThis triage tool based on the dimensions of obstruction, infection, kidney dysfunction, and other symptoms has good psychometric properties and significant utility for prioritizing patients with urolithiasis during times of crisis. With this system, patients of moderate to high priority were treated promptly during the COVID-19 pandemic.Supplementary InformationThe online version contains supplementary material available at 10.1007/s00345-021-03871-7.

The Head Control Scale: Interrater Reliability Among Therapy Students

Abstract Date Presented 04/13/21 This study assesses reliability and accuracy of the Head Control Scale (HCS) when used by inexperienced raters. Physical therapy and OT students used the HCS to rate five videotaped pediatric subjects. The kappa coefficient for interrater reliability among students was "almost perfect" (&amp;gt;.80). In one subscale, when comparing student raters with clinicians, there was strong agreement in grading between each group. The HCS may be consistently used by both new and experienced raters. Primary Author and Speaker: Amy Armstrong-Heimsoth Additional Authors and Speakers: Emily Mei Chun, Elizabeth Diane Hesse, Kelsey E. Ranneklev, and Camila E. Sanchez

Analysis of Potential for User Errors in Mobile Deployment of Radiology Deep Learning for Cardiac Rhythm Device Detection.

We examine how convolutional neural networks (CNNs) for cardiac rhythm device detection can exhibit failures in performance under suboptimal deployment scenarios and examine how medically adversarial image presentation can further impair neural network performance. We validated the publicly available Pacemaker-ID web server and mobile app on 43 local hospital emergency department (ED) cases of patients presenting with a cardiac rhythm device on anterior-posterior (AP) chest radiograph and assessed performance using Cohen's kappa coefficient for inter-rater reliability. To illustrate adversarial performance concerns, we then produced example CNN models using the 65,379 patient MIMIC-CXR chest radiograph retrospective database and evaluated performance with area under the receiver operating characteristic (AUROC). In retrospective review of 43 patients with cardiac rhythm devices on AP chest radiographs during our study period (January 1, 2020 to March 1, 2020), 74.4% (32/43) had device manufacturer information readily available within the electronic medical record. A total of 25.6% of patients (11/43) did not have this information documented in the patient chart and could ostensibly benefit from CNN-based identification of device manufacturer. For patients with known device manufacturer, the Pacemaker-ID prediction was accurate in 87.5% of cases (28/32). Mobile app accuracy varied from 62.5 to 93.75% depending on image capture settings and presentation. Cohen's kappa coefficient varied from 0.448 to 0.897 depending on mobile image capture conditions. For our additional analysis of medically adversarial performance failures with a DenseNet121 trained on MIMIC-CXR images, we showed that an AUROC of 0.9807 ± 0.0051 could be achieved on an example testing dataset while masking a 30% false positive rate in identification of cardiac rhythm devices versus clinically distinct entities such as vagal nerve stimulators. Despite the promise of CNN approaches for cardiac rhythm device analysis on chest radiographs, further study is warranted to assess potential for errors driven by user misuse when deploying these models to mobile devices as well as for cases when performance can be impaired by the presence of other support apparatuses.

Crowdsourcing as Content Collaboration for STEM Edutainment

In this project, crowdsourcing science, technology, engineering and mathematics (STEM) content were used to promote enjoyable, challenge-based English language gamification to young ESL learners and instructors altogether. The aim is to optimize the participants’ engagement in learning STEM disciplines using the target language. However, relevant literature in this area shows inadequate empirical evidence on engagement when these two activities combined are implemented in real-life settings. This research therefore, was conducted to explore the participants’ engagement in learning STEM contents, outside their classroom setting, using crowdsourcing and gamification activities. Through needs analysis of 48 participants (school children aged 13 to 14 years) who were assisted by 20 university undergraduates to be involved in the ‘Young Scientist Camp’ project, it was discovered that the participants had minimal exposure to the use of technology as well as the language in learning STEM disciplines. The participants were assigned to crowd-source for online STEM contents because the target is to maximize the use of English language. The contents were used to form several questions which they then took turns to test their peers from other groups using Kahoot! The qualitative data of the study were gathered via video recorded interaction, observations, and focus group interviews. Tesch’s thematic analysis, Kappa coefficient for inter-rater reliability and an observation checklist using Kapp’s motivational characteristics of game elements were used to determine crowdsourcing characteristics and elements of engagement from the activities. Interestingly, the pupils showed evidence of engagement when faced by unexpected problems in their groups. They also expressed strong engagement when the autonomy was given to them in deciding the contents and flow of the activities, which was evidence in the process of completing the tasks. This implicates emerging recommendations in engaging young learners via crowdsourcing techniques and gamification to foster interest in learning the language for STEM.

P087: A comparison of how emergency physicians and plastic surgeons evaluate and triage pediatric hand fractures: a prospective trial of the Calgary Kids’ Hand Rule

Introduction: Hand fractures in children are common and most are adequately managed with immobilization alone. There is a subset of fractures that require surgery as well as a fear of growth plate disturbance. For these reasons, triaging the so-called “complex” fractures that require specialized care by a hand surgeon is critical. In an effort to improve triaging for pediatric hand fractures, we previously derived and internally validated a prediction model for pediatric hand fracture triage using multivariable logistic regression with bootstrapping. The primary outcome was “complex fracture”, a definition we assigned to any fractures that required surgery, closed reduction or more than four appointments with a plastic surgeon. The model identified six significant predictors of complex fractures: angulation, condylar involvement, dislocation or subluxation, displacement, open fracture, and malrotation with strong performance (C-statistic 0.88) and was named the Calgary Kids’ Hand Rule (CKHR). Methods: A prospective cohort study was conducted at the Alberta Children's Hospital from April 1 until December 31, 2019. Eligible patients included children 17 years and younger with a radiographically confirmed hand fracture. Both emergency physicians and plastic surgeons completed independent CKHR forms for each new hand fracture. The fracture was predicted as “complex” if any one of the six predictors were present on the form. If none of the six predictors were present, the predicted outcome was “simple”. The observed outcome was “complex” if the fracture required surgery, closed reduction, or four or more appointments with a plastic surgeon at three months follow-up. All other fractures were observed outcome “simple”. The classification performance of the CKHR was assessed via sensitivity, specificity, and C-statistic. The kappa coefficient for inter-rater reliability between emergency physicians and plastic surgeons was calculated for each predictor. Results: To date, 102 pediatric hand fractures have been included in this prospective cohort study. Of the 74 observed simple fractures, 49 were predicted as “simple” and 25 were predicted as “complex”. Of the 28 observed “complex” fractures, 25 were predicted as “complex” and 3 were predicted as “simple”. These findings correspond to a sensitivity of 89%, specificity of 66%, and a C-statistic of 0.78. Of the 3 observed “complex” fractures that were predicted as “simple”, i.e. the 3 false negatives, one was a Seymour fracture of the fourth distal phalanx for which the emergency physician did not tick any boxes on the form. Upon further investigation, we learned that the physician had commented that the fracture was open, thus alluding to their acknowledgement of the predictor “open fracture” as being present). This fracture went on to require surgery. The second false-negative fracture was a non-displaced, intra-articular fracture of the fourth metacarpal head that required multiple appointments with the plastic surgeon. The third false-negative fracture was a non-displaced Salter-Harris II fracture of the thumb proximal phalanx without malrotation that received a closed reduction by the emergency physician. The kappa coefficient for inter-rater reliability between emergency physician and plastic surgeon evaluation of predictors varied by predictor from fair to almost perfect agreement. Condylar involvement had the highest kappa coefficient (kappa = 0.85) followed by malrotation (kappa = 0.65) and dislocation (kappa = 0.64). The predictors with the lowest kappa coefficients were displacement (kappa = 0.42), open fractures (kappa = 0.50), and angulation (kappa = 0.53). Conclusion: The Calgary Kids’ Hand Rule had a sensitivity of 89% in a prospective cohort of pediatric hand fractures referred to the Alberta Children's Hospital. The sensitivity could likely be improved with knowledge translation and specific education regarding use of the prediction tool. Emergency physicians and plastic surgeons displayed the lowest inter-rater reliability when assessing displacement, open fractures, and angulation. These predictors may represent areas of future research and physician education to delineate and decrease the discordance between emergency physicians and plastic surgeons.

Retrospective frailty determination in critical illness from a review of the intensive care unit clinical record.

Frailty is one of the major challenges for intensive care, affecting one-third of intensive care unit patients and being associated with a range of poor health outcomes. Determination of frailty in critical illness using the Clinical Frailty Scale has recently been adopted by the Australian and New Zealand Intensive Care Society, but it is not known whether this is able to be measured from the clinical record without interviewing patients or their relatives. The aims of this retrospective cohort study were to test whether a Clinical Frailty Scale score could be assigned in an intensive care unit population from the clinical record, and to assess the inter-rater reliability of frailty measured in this manner. A total of 144 patients were enrolled. Of these, 137 (95%) were able to have a Clinical Frailty Scale score assigned, and 22 (15%) were scored as frail (Clinical Frailty Scale ≥5). Cohen’s kappa coefficient for inter-rater reliability between assessors was 0.67, confirming substantial agreement. Consistent with other critically ill cohorts, frailty was associated on multivariate analysis with age, Charlson comorbidity score, dependence with activities of daily living, and limitation of medical treatment, indicating validity of this approach to frailty measurement. Our results imply that frailty measurement is possible and feasible from the intensive care unit clinical record, which is of importance as routine measurement and reporting of frailty in intensive care units in our region increases. Future work should seek to validate an assigned Clinical Frailty Scale score with that obtained directly from patients or their next of kin.

Implementation of a Quality Index for Improvement of Quantification of Corneal Nerves in Corneal Confocal Microcopy Images: A Multicenter Study.

Corneal confocal microscopy (CCM) is an imaging method to detect loss of nerve fibers in the cornea. The impact of image quality on the CCM parameters has not been investigated. We developed a quality index (QI) with 3 stages for CCM images and compared the influence of the image quality on the quantification of corneal nerve parameters using 2 modes of analysis in healthy volunteers and patients with known peripheral neuropathy. Images of 75 participants were a posteriori analyzed, including 25 each in 3 image quality groups (QI 1-QI 3). Corneal nerve fiber length (CNFL) was analyzed using automated and semiautomated software, and corneal nerve fiber density and corneal nerve branch density were quantified using automated image analysis. Three masked raters assessed CCM image quality (QI) independently and categorized images into groups QI 1-QI 3. In addition, statistical analysis was used to compare interrater reliability. Analysis of variance was used for analysis between the groups. Interrater reliability analysis between the image ratings was performed by calculating Fleiss' kappa and its 95% confidence interval. CNFL, corneal nerve fiber density, and corneal nerve branch density increased significantly with QI (P < 0.001, all post hoc tests P < 0.05). CNFL was higher using semiautomated compared with automated nerve analysis, independent of QI. Fleiss kappa coefficient for interrater reliability of QI was 0.72. The quantification of corneal nerve parameters depends on image quality, and poorer quality images are associated with lower values for corneal nerve parameters. We propose the QI as a tool to reduce variability in quantification of corneal nerve parameters.

Inter- and intra-rater reliability of vertebral fracture classifications in the Swedish fracture register.

AIMTo investigate the inter- and intra-rater reliability of the vertebral fracture classifications used in the Swedish fracture register.METHODSRadiological images of consecutive patients with cervical spine fractures (n = 50) were classified by 5 raters with different experience levels at two occasions. An identical process was performed with thoracolumbar fractures (n = 50). Cohen’s kappa was used to calculate the inter- and intra-rater reliability.RESULTSThe mean kappa coefficient for inter-rater reliability ranged between 0.54 and 0.79 for the cervical fracture classifications, between 0.51 and 0.72 for the thoracolumbar classifications (overall and for different sub classifications), and between 0.65 and 0.77 for the presence or absence of signs of ankylosing disorder in the fracture area. The mean kappa coefficient for intra-rater reliability ranged between 0.58 and 0.80 for the cervical fracture classifications, between 0.46 and 0.68 for the thoracolumbar fracture classifications (overall and for different sub classifications) and between 0.79 and 0.81 for the presence or absence of signs of ankylosing disorder in the fracture area.CONCLUSIONThe classifications used in the Swedish fracture register for vertebral fractures have an acceptable inter- and intra-rater reliability with a moderate strength of agreement.

Adaptation and Reliability of the Structured Clinical Interview for DSM-5-Disorders - Clinician Version (SCID-5/CV) to the Turkish Language

In this study, we aimed to adapt the Structured Clinical Interview for DSM-5-ClinicianVersion into Turkish and to demonstrate its reliability. METHOD: A total of 185 patients, both inpatient and outpatient, from two different university hospitals were included. Training sessions on the features and use of SCID-5/CV were held before the data collection. During the study, in order to test the diagnostic agreement and accuracy, two psychiatrists remained present at the evaluation of each participant; alternatively being interviewer and the observer. Cohen's kappa coefficient for inter-rater reliability was calculated for every diagnostic category. RESULTS: The patient group had a mean age of 37.2 (±13.5) years and 55.7% were female. The education status was as follows: 2.7% were illiterate, 1.7% literate with no primary education, 33% had primary education, 23.8% had secondary education and 38.9% had higher education. The calculated kappa value showed excellent agreement for schizophrenia (κ=0.93), bipolar disorder (κ=0.96), major depressive disorder (κ=0.89), dysthymic disorder (κ=0.82), alcohol use disorder (κ=0.96), panic disorder (κ=0.84), agoraphobia (κ=0.85), social anxiety disorder (κ=0.95), generalized anxiety disorder (κ=0.89), obsessive compulsive disorder (κ=0.87), posttraumatic stress disorder (κ=0.89), adult attention deficit and hyperactivity disorder (κ=1.00), specific phobias (κ=0.82) and very good agreement with adjustment disorder (κ=0.78) and somatic symptom disorder (κ=0.65). CONCLUSION: Similar to the past SCID versions, kappa values were found to be quite high and all were statistically significant. The Turkish version of SCID-5/ CV can be reliably used in both clinical practice and clinical studies.

LO76: Can emergency physicians perform carotid artery ultrasound to detect severe stenosis in patients with TIA and stroke?

Introduction: Carotid artery stenosis (CAS) is a common cause of stroke. Patients with severe, symptomatic CAS can have their subsequent stroke risk reduced by carotid endarterectomy or stenting when completed soon after a TIA or non-disabling stroke. Patients presenting to a peripheral ED with TIA/stroke, may require transfer to another hospital for imaging to rule-out CAS. The purpose of this study was to determine the test characteristics of carotid artery POCUS in detecting greater than 50% stenosis in patients presenting with TIA/stroke. Methods: We conducted a prospective cohort study on a convenience sample of adult patients presenting to a tertiary care academic ED with TIA/stroke between June and October 2017. Carotid POCUS was performed by a trained medical student or a trained emergency physician. Our outcome measure, CAS &gt;50% was determined by the final radiology report of CTA imaging by a trained radiologist, blinded to our study. A blinded POCUS expert reviewed the carotid POCUS scans. We calculated the sensitivity and specificity for CAS &gt;50% using carotid POCUS versus the gold standard of CTA. Results: We enrolled 75 patients of which 5 did not meet inclusion criteria. The mean age was 70.4 years, 57% were male. 16% were diagnosed with greater than 50% CAS. 47% were stroke codes and 37% were admitted to hospital. Carotid POCUS had a sensitivity and specificity of 72% (46%-99%) and 88% (80%-96%) respectively. There were three false negatives of which two were exactly 50% ICA stenosis on CTA and the other was 100% occlusion of the distal ICA. Kappa coefficient for inter-rater reliability between standard and expert interpretation was 0.68 for moderate agreement. The scan took a mean time of 6.2 minutes to complete. Conclusion: Carotid POCUS has moderate correlation with CTA for detection of CAS greater than 50%. Carotid POCUS identified all the critical 70-99% stenosis lesions that would need urgent surgery. Further research is needed to confirm these findings.

Appropriateness of patients transferred with orthopedic injuries: experience of a level I trauma center.

Trauma patients are frequently transferred to a higher level of care for specialized orthopedic care. Many of these transfers are not necessary and waste valuable resources. The purpose of this study was to quantify our own experience and to assess the appropriateness of orthopedic transfers to a level I trauma center emergency department. A retrospective review of orthopedic emergency department transfers to a level I trauma center was performed. Data collected included time of transfer, injury severity score (ISS), age, gender, race, orthopedic coverage at transfer institution, and insurance status. Two orthopedic trauma surgeons graded the appropriateness of transfer. A weighted logistic regression model was used to compare dependent and independent variables. A total of 324 patient transfers were reviewed; 65 (20.1%) of them were graded as inappropriate. There was no statistically significant relationship between appropriateness of transfer and age, availability of orthopedic coverage, night/weekend transfer, or insurance status. Regression analysis showed that only ISS (OR 1.130, p=.008) and "polytrauma" (OR 25.39, p<.0001) designation were associated with increased odds ratio of appropriate transfer. The kappa coefficient for inter-rater reliability between the two raters was 0.505 (95% CI, 0.388-0.623) reflecting moderate agreement. Inappropriate transfers create a significant medical burden to our health care system using valuable resources. Our study found similar results of inappropriate transfers compared to previous studies. However, we did not find a relationship between insurance status or nights/weekends and transfer appropriateness.

Fish scale artefact on an intraoral imaging receptor.

To describe an artefact, termed the fish scale artefact, present on an intraoral imaging receptor. Thirty brand new DIGORA Optime photostimulable phosphor (PSP) plates (Soredex/Orion Corp., Helsinki, Finland) were imaged using the dental digital quality assurance radiographic phantom (Dental Imaging Consultants LLC, San Antonio, TX). All PSP plates were scanned at the same spatial resolution (dpi) using the high resolution mode. Two evaluators assessed all 30 plates. Each evaluator assessed the 30 PSP plates separately for purposes of establishing interrater reliability, and then together in order to obtain the gold standard result. The fish scale artefact was detected on 46.7% of the PSP plates. The kappa coefficient for interrater reliability was 0.86 [95% CI (0.69-1.00)], indicating excellent interrater reliability. For Evaluator 1, sensitivity was 0.85 [95% CI (0.55-0.98)]; specificity was 0.94 [CI (0.71-1.00)] and overall accuracy was 0.90 [95% CI (0.73-0.98)]. For Evaluator 2, sensitivity was 1.00 [95% CI (0.75-1.00)]; specificity was 0.94 [CI (0.71-1.00)] and overall accuracy was 0.97 [95% CI (0.83-1.00)]. These results indicate excellent agreement with the gold standard for both evaluators. Utilizing a comprehensive quality assurance protocol, we identified a fish scale artefact inherent to the image receptor. Additional research is needed to determine if the artefact remains static over time or if it increases over time. Likewise, research to determine the potential sources contributing to an increase in the artefact is needed.

Single leg squat performance in physically and non-physically active individuals: a cross-sectional study

BackgroundSingle-leg squat (SLS) is a functional test visually rated by clinicians for assessing lower limb function as a preventive injury strategy. SLS clinical rating is a qualitative evaluation and it does not count objective outcomes as kinematics data and surface electromyography (sEMG) assessment. Based on the SLS rating, the aims of this study were (i) to determine the clinical rating agreement among six raters and (ii) to assess kinematic and sEMG predictors of good SLS performance in physically and non-physically active individuals.MethodsSeventy-two healthy adults, divided in physically active and non-physically active groups, performed three SLSs on their dominant leg. Clinical ratings, kinematic data and sEMG were acquired. By using a validated clinical scale, six expert clinicians rated each SLS watching a video at three different time points. Intra and inter-rater agreement of clinical ratings were undertaken and a binary logistic regression analysis was used to determine kinematic and sEMG as predictors of SLS performance.ResultsThe weighted kappa coefficient for intra-rater reliability within each rater ranged between moderate and almost perfect agreement (0.55–0.85) whereas the weighted kappa coefficient for inter-rater reliability among raters was fair (0.34, time point 0; 0.31, time point 1; 0.30, time point 2). SLS analyses of physically active compared to non-physically active group showed a statistically significant difference in knee flexion and hip flexion (p = 0.041 and p = 0.023 respectively) and no difference in clinical ratings (p = 0.081). Greater knee flexion can predict the good SLS performance taking into account the belonging group (p = 0.019).ConclusionsPhysically active individuals seemed to be at less risk to perform a non-good SLS and they had greater knee and hip flexions kinematics than non-physically active individuals. Knee flexion can predict the SLS performance quality therefore a greater knee flexion might also be considered a protective element from injuries.Trial registrationClinicalTrials.gov identifier (trial has been registred retrospectively: NCT03203083. Date registration: June 21, 2017.

Investigating the accuracy of a novel telehealth diagnostic approach for autism spectrum disorder.

Research indicates that a substantial amount of time elapses between parents' first concerns about their child's development and a formal diagnosis of autism spectrum disorder (ASD). Telehealth presents an opportunity to expedite the diagnostic process. This project compared a novel telehealth diagnostic approach that utilizes clinically guided in-home video recordings to the gold standard in-person diagnostic assessment. Participants included 40 families seeking an ASD evaluation for their child and 11 families of typically developing children. Children were between the ages of 18 months and 6 years 11 months; mean adaptive behavior composite = 75.47 (SD = 15.94). All parent participants spoke English fluently. Families completed the Naturalistic Observation Diagnostic Assessment (NODA) for ASD, which was compared to an in-person assessment (IPA). Agreement between the 2 methods, as well as sensitivity, specificity, and interrater reliability, were calculated for the full sample and the subsample of families seeking an ASD evaluation. Diagnostic agreement between NODA and the IPA was 88.2% (κ = 0.75) in the full sample and 85% (κ = 0.58) in the subsample. Sensitivity was 84.9% in both, whereas specificity was 94.4% in the full sample and 85.7% in the subsample. Kappa coefficients for interrater reliability indicated 85% to 90% accuracy between raters. NODA utilizes telehealth technology for families to share information with professionals and provides a method to inform clinical judgment for a diagnosis of ASD. Due to the high level of agreement with the IPA in this sample, NODA has potential to improve the efficiency of the diagnostic process for ASD. (PsycINFO Database Record

Training and Validation of Standardized Patients for Assessing Communication and Counseling Skills of Pharmacy Students: A Pilot Study.

Objective:The objective of this study is to describe the process of training valid simulated patients (SPs) for assessing communication and counseling skills of pharmacy students’ performance.Methods:This is a cross-sectional and correlational study. Psychometric properties of checklist and SPs’ portrayals and their filling of the checklist regarding assessing pharmacy students were assessed. Five SPs who were working in the simulated patient's pool were volunteered to take part in the project, which one of the SPs failed. Three scenarios, along with corresponding checklists, were developed based on the usual medications of different diseases consisting of asthma, respiratory infections, and osteoporosis. The SPs’ role-play performance was video-recorded and rated independently by two experts according to an observational rating scale to assess validity. The role-play was repeated after 1 week with the same scenario and the same doctor, to assess test-retest reliability. The inter-rater agreement between SPs and experts was determined by calculating the intraclass correlation coefficient and kappa coefficient.Findings:The four eligible SPs were all women, with an average age of 37 years. The correlation between mean scores of raters and mean scores of SPs was 0.91 and 0.85, respectively. The Pearson's correlation between mean scores of raters with SPs was 0.75. The checklists’ reliability, Cronbach's alpha, was calculated to be 0.72. The measured weighted Cohen's kappa for the ratings of by each SP, and the gold standard was between 0.53 and 0.57, indicating a moderate agreement. The inter-rater reliability kappa coefficient between raters was 0.75 (P = 0.01).Conclusion:The authors have demonstrated the technique of using standardized patients to evaluate communication and counseling skills of pharmacy students. The findings indicated that trained SPs can be used as an effective tool to assess pharmacy students’ communication and counseling skills.

Reliability and Validity of a Tool to Measure the Severity of Dysphagia: The Food Intake LEVEL Scale

ContextDysphagia is one of the most prevalent and distressing symptoms among palliative care patients, and a practical assessment tool is required. ObjectivesThe aim of this study was to examine the reliability and validity of a tool to measure the severity of dysphagia: the Food Intake LEVEL Scale (FILS), a 10-point observer-rating scale. MethodsThe inter- and intrarater reliability was evaluated by three clinicians in 30 patients using weighted kappa statistics. The convergent validity was evaluated by examining correlations of FILS with the Functional Oral Intake Scale (FOIS) and patient-reported satisfaction levels with oral intake. ResultsWeighted kappa coefficients for interrater reliability ranged from 0.70 to 0.90 and those for intrarater reliability ranged from 0.83 to 0.90. The FILS score was highly associated with the FOIS (ρ = 0.96–0.99) and patient-reported satisfaction (ρ = 0.89). ConclusionThe FILS seems to have fair reliability and validity as a practical tool for assessing the severity of dysphagia. Further study on the reliability, validity, and sensitivity of the FILS compared with the FOIS is needed.

Optimization of Magnetic Resonance Imaging of the Anterior Bundle of the Ulnar Collateral Ligament: A Randomized Controlled Trial of 3 Patient Positions (SS-26)

Optimization of Magnetic Resonance Imaging of the Anterior Bundle of the Ulnar Collateral Ligament: A Randomized Controlled Trial of 3 Patient Positions (SS-26)