Kappa Range Research Articles

Psychometric properties of the List of Threatening Experiences—LTE and its association with psychosocial factors and mental disorders according to different scoring methods

BackgroundThe List of Threatening Experiences (LTE) questionnaire is frequently used to assess stressful events; however, studies of its psychometric properties are scarce. We examined the LTE's reliability, factorial structure, construct validity and explored the association between LTE scores and psychosocial variables and mental disorders. MethodThis study involved interviewing 5442 primary care attendees from Spain. Associations between four different methods of quantifying LTE scores, psychosocial factors, major depression (CIDI), anxiety disorders (PRIME-MD), alcohol misuse and dependence (AUDIT) were measured. ResultsThe LTE showed high test–retest reliability (Kappa range=0.61–0.87) and low internal consistency (α=0.44). Tetrachoric factorial analysis yielded four factors (spousal and relational problems; employment and financial problems; personal problems; illness and bereavement in close persons). Logistic multilevel regression found a strong association between greater social support and a lower occurrence of stressful events (OR range=0.36–0.79). The association between religious–spiritual beliefs and the LTE, was weaker. The association between mental disorders and LTE scores was greater for depression (OR range=1.64–2.57) than anxiety (OR range=1.35–1.97), though the highest ORs were obtained with alcohol dependence (OR range=2.86–4.80). The ordinal score (ordinal regression) was more sensitive to detect the strength of association with mental disorders. LimitationsWe are unable to distinguish the direction of the association between stressful events, psychosocial factors and mental disorders, due to our cross-sectional design of the study. ConclusionsThe LTE is a valid and reliable measure of stress in mental health, and the strength of association with mental disorders depends on the method of quantifying LTE scores.

A targeted method for standardized assessment of adverse drug events in surgical patients

This study demonstrates the development, reliability and outcome of a targeted method for standardized assessment of adverse drug events (ADEs) in surgical patients. Initial practice evaluation of this ADE assessment method was carried out in a prospective single centre cohort study. In total, 262 electively admitted surgical patients were included. The surgical trigger tool was applied to patients' medical records by two independent reviewers, and subsequent assessment of causality, severity and preventability of ADEs was carried out by two independent expert panels consisting of a consultant surgeon and a clinical pharmacologist. The surgical trigger tool and causality assessment method were each tested on reliability in a separate group of 50 randomly selected patients using Fleiss and Cohen's kappa statistics and percentages of agreement. Comparison of this method with an existing trigger tool method for ADEs was performed. Our surgical trigger tool contains 51 triggers. The inter- and intra-rater calculations showed substantial to almost perfect levels of agreement (kappa range 0.71-0.83), with a 97.8-98.5% percentage of agreement. Fair to substantial levels of agreement were calculated for causality, severity and preventability (kappa range 0.38-0.79). The percentages of inter- and intra-rater agreement were 68.9 and 70.5% for causality, 67.0 and 82.0% for severity, and both 98.4% for preventability, respectively. Compared with the existing trigger tool method for ADEs, we found an additional 363 triggers, 18 ADEs (an extra 20%) and 3 preventable ADEs in our surgical cohort. This targeted trigger tool for standardized assessment of ADEs in surgical patients shows excellent agreement between reviewers. The assessment of medication-related harm had acceptable agreement. Compared with an existing ADE trigger tool method, the present method found almost 20% extra ADEs. This method can be a useful alternative to existing trigger tool methods, in particular to assess medication safety in surgical patients.

Development and psychometric evaluation of the Discrimination and Stigma Scale (DISC)

Mental illness is associated with unfair treatment in a number of areas of life. There is currently no psychometrically validated measure that has been developed to specifically focus on such experienced discrimination. This study aimed to finalise the Discrimination and Stigma Scale (DISC) and establish its psychometric properties. The DISC was further developed using (1) service user and interviewer focus groups; (2) reading ease testing; and (3) cognitive debriefing interviews. The revised scale then underwent psychometric testing to establish the following properties: reliability; validity; precision; acceptability; and feasibility. The final 22-item DISC demonstrated good psychometric properties (n=86) including inter-rater reliability (weighted kappa range: 0.62–0.95), internal consistency (α=0.78) and test–retest reliability (n=46) (weighted kappa range: 0.56–0.89). Feasibility, validity and acceptability were also established. In conclusion, the 22-item DISC is recommended for use in measuring experienced stigma and discrimination. Additional work to develop a measure of anticipated stigma is recommended.

Performance analysis for decision making in team sports

Decision making is a key aspect of expert performance and is important in many sports. However it has been largely ignored in notational analysis. The aim of this study was to design and test a reliable method of analysing decision-making performance and to use it to evaluate decision making and transfer of training into competition matches. Thirteen elite Australian football (AF) players were analysed over four matches (early season and late season), using a custom-designed decision-making notational analysis system. The performance indicator, decision accuracy, was based on a three-point scale allocated by three elite AF coaches. Other factors measured included number of options available, level of defensive pressure, match context and execution elements. Inter-rater reliability of the notational analysis system was high for all performance indicators (kappa range = .79 - .98). Decision accuracy increased from early to late season while defensive pressure and number of options available for each decision did not differ between games. This research creates an reliable new platform for future research to build upon in order to further develop our ability to measure cognitive skills such as decision making in live match situations, and to also effectively measure transfer of performance gains through off field training interventions.

Ascertainment of chronic diseases using population health data: a comparison of health administrative data and patient self-report

BackgroundHealth administrative data is increasingly being used for chronic disease surveillance. This study explored agreement between administrative and survey data for ascertainment of seven key chronic diseases, using individually linked data from a large population of individuals in Ontario, Canada.MethodsAll adults who completed any one of three cycles of the Canadian Community Health Survey (2001, 2003 or 2005) and agreed to have their responses linked to provincial health administrative data were included. The sample population included 85,549 persons. Previously validated case definitions for myocardial infarction, asthma, diabetes, chronic lung disease, stroke, hypertension and congestive heart failure based on hospital and physician billing codes were used to identify cases in health administrative data and these were compared with self-report of each disease from the survey. Concordance was measured using the Kappa statistic, percent positive and negative agreement and prevalence estimates.ResultsAgreement using the Kappa statistic was good or very good (kappa range: 0.66-0.80) for diabetes and hypertension, moderate for myocardial infarction and asthma and poor or fair (kappa range: 0.29-0.36) for stroke, congestive heart failure and COPD. Prevalence was higher in health administrative data for all diseases except stroke and myocardial infarction. Health Utilities Index scores were higher for cases identified by health administrative data compared with self-reported data for some chronic diseases (acute myocardial infarction, stroke, heart failure), suggesting that administrative data may pick up less severe cases.ConclusionsIn the general population, discordance between self-report and administrative data was large for many chronic diseases, particularly disease with low prevalence, and differences were not easily explained by individual and disease characteristics.

Spanish translation and validation of four short pelvic floor disorders questionnaires

Globally, Spanish is the primary language for 329 million people; however, most urogynecologic questionnaires are available in English. We set out to develop valid Spanish translations of the Questionnaire for Urinary Incontinence Diagnosis (QUID), the Three Incontinence Questions (3IQ), and the short Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Floor Impact Questionnaire (PFIQ-7). The TRAPD method (translation, review, adjudication, pretesting, and documentation) was used for translation. Eight native Spanish-speaking translators developed Spanish versions collaboratively. These were pretested with cognitive interviews and revised until optimal. For validation, bilingual patients at seven clinics completed Spanish and English questionnaire versions in randomized order. Participants completed a second set of questionnaires later. The Spanish versions' internal consistency and reliability and Spanish-English agreement were measured using Cronbach's alpha, weighted kappa, and intraclass correlation coefficients. A total of 78 subjects were included; 94.9 % self-identified as Hispanic and 73.1 % spoke Spanish as their primary language. The proportion of per-item missing responses was similar in both languages (median 1.3 %). Internal consistency for Spanish PFDI-20 subscales was acceptable to good and for PFIQ-7 and QUID excellent. Test-retest reliability per item was moderate to near perfect for PFDI-20, substantial to near perfect for PFIQ-7 and 3IQ, and substantial for QUID. Spanish-English agreement for individual items was substantial to near perfect for all questionnaires (kappa range 0.64-0.95) and agreement for PFDI-20, PFIQ-7, and QUID subscales scores was high [intraclass correlation coefficient (ICC) range 0.92-0.99]. We obtained valid Spanish translations of the PFDI-20, PFIQ-7, QUID, and 3IQ. These results support their use as clinical and research assessment tools in Spanish-speaking populations.

Prescription refill, patient self-report and physician report in assessing adherence to oral endocrine therapy in early breast cancer patients: a retrospective cohort study in Catalonia, Spain

Aims:To compare different methods in order to assess adherence and persistence with oral endocrine therapy in women diagnosed with breast cancer (BC) in Catalonia.Materials and methods:This study covered all women newly diagnosed with stage I, II or IIIa BC and positive hormone receptors at six hospitals in Catalonia (Spain) in 2004. Adherence was assessed on the basis of physician report and patient self-report using a telephone questionnaire. Persistence was measured by refill prescriptions. We used the Kappa index to compare adherence measures and logistic regression to evaluate adherence-related risk factors.Results:The study covered a total of 692 women. Adherence ranged from 92% (self-report) to 94.7% (physician report), depending on the measure used; persistence was 74.7% at 5 years of follow-up. Low concordance between measures was observed (Kappa range: 0.018–0.267). Patients aged 50–74 years showed higher adherence than those aged <50 years. Adherence was also associated with: adjuvant chemotherapy and sequential hormonal therapy.Conclusions:Concordance between the different measures was remarkably low, indicating the need for further research. Adherence is an issue in the management of BC patients taking oral drugs, and should be assessed in clinical practice.

An Evaluation of Bagging, Boosting, and Random Forests for Land-Cover Classification in Cape Cod, Massachusetts, USA

The iterative and convergent nature of ensemble learning algorithms provides potential for improving classification of complex landscapes. This study performs land-cover classification in a heterogeneous Massachusetts landscape by comparing three ensemble learning techniques (bagging, boosting, and random forests) and a non-ensemble learning algorithm (classification trees) using multiple criteria related to algorithm and training data characteristics. The ensemble learning algorithms had comparably high accuracy (Kappa range: 0.76-0.78), which was 11% higher than that of classification trees. Ensemble learning techniques were not influenced by calibration data variability, were robust to one-fifth calibration data noise, and insensitive to a 50% reduction in calibration data size.

Inter-Rater Reliability of Ohio School-Based Overweight and Obesity Surveillance Data

Measurement of height and weight in large studies may force the use of multiple measurers. The purpose of this study was to evaluate the reliability of height, weight, and body mass index (BMI) measures collected by multiple measurers in a large, statewide BMI surveillance program. A random subsample of schools (n=30) was selected from schools that participated in the 2009 to 2010 Ohio third-grade Oral Health/BMI surveillance program. Children (n=1,189) were measured by multiple volunteer health professional measurers and again by a trained researcher, who was standard across all schools. Mean differences for height, weight, and BMI percentiles were calculated for BMI category classifications. Agreement was estimated by the reliability coefficient, McNemar's test, and Kappa statistic. Sensitivity, specificity, and positive and negative predictive values were estimated using the trained researcher measures as the reference. Overall mean differences (95% confidence interval) were 0.45 (0.41-0.48) cm for height, 0.07 (−0.01-0.15) kg for weight, and 1.37 (1.20-1.53) for BMI. The correlation coefficient for all three measures was over 0.9 (P<0.01), indicating a strong positive association between measures. BMI category classifications showed substantial reliability (Kappa range: 0.94-0.96). Percentage agreement ranged from 98% to 99% for all BMI categories, as did sensitivities and specificities. Positive predictive values for all BMI categories were approximately 97%, and close to 100% for negative predictive values. Reliability for height, weight, BMI percentile, and BMI classification was very high, supporting the use of multiple trained measurers in a statewide BMI surveillance program. Similar methods can be applied to other public health and clinical settings to improve anthropometric measurement reliability.

Patient and caregiver satisfaction with ambulatory oncology care: Agreement and predictors.

e16567 Background: Little is known about the level of agreement between patient and caregiver individual reports of satisfaction with healthcare, and no such study has been conducted in the advanced cancer setting. Our aims were to assess the level of agreement in satisfaction with oncology care, between patients with advanced cancer and their caregivers, and to identify factors associated with satisfaction. Methods: Patients with advanced cancer and their caregivers were recruited from ambulatory oncology clinics. Satisfaction with care was measured using FAMCARE- patient and caregiver versions. Patients completed measures of symptom severity (ESAS) and quality of life (FACT-G, FACIT-Sp). Caregivers completed a quality of life measure (CQOL-C). Agreement between patient and caregiver satisfaction scores was assessed using ICC and weighted kappa statistics; multivariable regression was used to determine individual predictors of satisfaction. Results: For the 191 patient-caregiver pairs, caregivers were less satisfied than patients (mean FAMCARE score 67.5 vs. 65.7 out of a possible 90, p=0.02). Overall agreement between patients and caregivers was moderate (ICC = 0.59). Agreement for individual items on FAMCARE was low (kappa range = 0.11-0.37). Both patients and caregivers were least satisfied with information on managing pain and information regarding prognosis. Factors associated with patient satisfaction were lower education level, better quality of life, and less symptom severity; caregiver satisfaction was associated with lower education levels, and better quality of life. Conclusions: Despite considerable discrepancy between caregiver and patient ratings, there was agreement regarding which elements of care needed most improvement. Greater attention to pain control and communication regarding prognosis would further improve patient and caregiver satisfaction with care in advanced cancer

Development and validation of a postmortem radiological alteration index: the RA-Index

This study aimed to derive an index quantifying the state of alteration of cadavers by quantifying the presence of gas in the body using postmortem multidetector computed tomography (MDCT) imaging, and to validate the index by defining its sensitivity and specificity. The RA (radiological alteration)-index was derived from postmortem MDCT data from 118 nontraumatically deceased people. To validate the index, 100 additional scanned bodies (50 % traumatically deceased) were retrospectively examined by two independent observers. Presence of gas at 82 sites was assessed by a radiologist, whereas a forensic pathologist only investigated the seven sites used for the RA-index. The RA-index was highly correlated to the overall presence of gas in all 82 sites (R(2) = 0.98 in the derivation set and 0.85 in the validation set). Semiquantitative evaluation of gas presence in each site showed moderate reliability (Cohen's kappa range, 0.41-0.78); nevertheless, the overall RA-index was very reliable (ICC(2,1) = 0.95; 95 % CI 0.92-0.96). Examiner using the RA-index detected heart cavities full of gas with a sensitivity of 100 % (95 % CI 51.7-100) and a specificity of 98.8 % (92.6-99.9). We conclude that determining the presence of gas at seven sites is a valid means to measure the distribution of gas due to cadaveric alteration in the entire body. The RA-index is rapid, easy-to-use, and reliable for nonexperienced users, and it is a valid method to suspect the normal presence of gas from cadaveric alteration. MDCT can be used to screen for gas embolism and to give indications for gas composition analysis (gas chromatography).

Prostate cancer treatment ascertained from several sources: analysis of disagreement and error

Treatment data for prostate cancer can be obtained from a variety of sources. Each of these sources has its own strengths and weaknesses and is subject to error. In a population-based cohort of 319 prostate cancer patients, data on treatment were obtained from five sources: two patient interviews at 6 and 12 months after diagnosis, primary caregiver interviews, physician questionnaires, and medical records. Inter-reporting agreement and accuracy of reporting (compared with medical records) were assessed. Multivariate analyses examined patient, caregiver, and physician characteristics as determinants of reporting error. The agreement among different reporting methods was generally good to excellent for prostatectomy and brachytherapy (kappa range 0.70-0.90) and fair to good (kappa range 0.35-0.75) for external beam radiation and hormonal treatment. Compared with medical records, the interview- and questionnaire-based data collection methods were more accurate for prostatectomy and brachytherapy than for external beam radiation and hormonal therapy. Using medical records as the 'gold standard', patient and caregiver interviews at 6 months after the diagnosis had higher sensitivity and specificity than other reporting sources. Interviews of prostate cancer patients and caregivers are useful alternatives to medical record abstraction, particularly if carried out during, or soon after, treatment.

Diagnosis of dysplasia in upper gastro-intestinal tract biopsies through digital microscopy

Background: Whole slide digital imaging (WSDI) offers an alternative to glass slides for diagnostic interpretation. While prior work has concentrated on the use of whole slide digital imaging for routine diagnostic cases, this study focuses on diagnostic interpretation of digital images for a highly challenging area, upper gastro-intestinal (GI) dysplasia. The aim of this study is to study the accuracy and efficiency of WSDI in the diagnosis of upper GI tract dysplasia. Materials and Methods: Forty-two hematoxylin and eosin (H and E)-stained slides representing negative, indefinite, low grade and high grade dysplasia were selected and scanned at 20× (Aperio XT). Four attending GI pathologists reviewed the WSDI, then glass slides, with at least 3–4 weeks between each media; glass slides were re-reviewed 16–18 months later. Results: Intraobserver variability for three clinically relevant categories (negative, indefinite/low grade, high grade) was wider for WSDI to glass (kappa range 0.36–0.78) than glass to glass (kappa range 0.58–0.75). In comparison to glass slide review, WSDI review required more time and was associated with an unexpected trend toward downgrading dysplasia. Conclusions: Our results suggest: (1) upper GI dysplasia can be diagnosed using WSDI with similar intraobserver reproducibility as for glass slides; however, this is not true for all pathologists; (2) pathologists may have a tendency to downgrade dysplasia in digital images; and (3) pathologists who use WSDI for interpretation of GI dysplasia cases may benefit from regular, on-going, re-review of paired digital and glass images to ensure the most accurate utilization of digital technology, at least in the early stages of implementation.

Validity and Reliability of a Korean Version of the National Institutes of Health Stroke Scale

Background and PurposeThe National Institutes of Health Stroke Scale (NIHSS) is a clinical assessment tool that is widely used in clinical trials and practice to evaluate stroke-related neurological deficits. The aim of this study was to determine the validity and reliability of the Korean version of the NIHSS (K-NIHSS) for evaluating Korean stroke patients.MethodsThe K-NIHSS was translated and adapted with regard to cultural and linguistic peculiarities. To examine its content validity, we quantified the Content Validity Index (CVI), which was rated by 11 stroke experts. The validity of the K-NIHSS was assessed by comparison with the Glasgow Coma Scale (GCS), the modified Rankin Scale (mRS), and the Barthel Index. The reliability of the K-NIHSS was evaluated using the unweighted kappa statistics for multiple raters and an intraclass correlation coefficient (ICC).ResultsThe CVI of the K-NIHSS reached 0.91-1.00. The median K-NIHSS score at baseline was 3 (interquartile range, 2-7), and the mean±SD score was 6.0±6.6. The baseline K-NIHSS had a significantly negative correlation with the GCS at baseline and the Barthel Index after 90 days. The K-NIHSS also had a significantly positive correlation with the mRS after 90 days. Facial paresis and dysarthria had moderate interrater reliability (unweighted kappa, 0.41-0.60); kappa values were substantial to excellent (unweighted kappa, >0.60) for all the other items. The ICC for the overall K-NIHSS score was 0.998. The intrarater reliability was acceptable, with a median kappa range of 0.524-1.000.ConclusionsThe K-NIHSS is a valid and reliable tool for assessing neurological deficits in Korean acute stroke patients.

Prediction for steatosis in type-2 diabetes: clinico-biological markers versus 1H-MR spectroscopy

The SteatoTest, fatty liver index (FLI) and hepatic steatosis index (HSI) are clinico-biological scores of steatosis validated in general or selected populations. Serum adiponectin (s-adiponectin) and retinol binding protein 4 (s-RBP4) are adipokines that could predict liver steatosis. We investigated whether the Steatotest, FLI, HSI, s-adiponectin and s-RBP4 could be valid predictors of liver steatosis in type-2 diabetic (T2D) patients. We enrolled 220 consecutive T2D patients. Reference standard was 3.0 T (1)H-MR spectroscopy (corrected for T1 and T2 decays). Intraclass correlation coefficients (ICCs), Kappa statistic measures of agreement, receiver operating characteristic (ROC) curves were assessed. Median liver fat content was 91 mg triglyceride/g liver tissue (range: 0-392). ICCs among the Steatotest, FLI, HSI, s-adiponectin, s-RBP4 and spectroscopy were low: 0.384, 0.281, 0.087, -0.297 and 0.048. Agreement between scores and spectroscopy was poor (Kappa range: 0.042-0.281). The areas under the ROC curves were low: 0.674, 0.647, 0.637, 0.616 and 0.540. S-adiponectin and s-RBP4 levels were strongly related to the presence of diabetic nephropathy (P = 0.0037 and P = 0.004; Mann-Whitney). The SteatoTest, FLI, HSI, s-adiponectin, s-RBP4 are not valid predictors of steatosis in T2D patients. Clino-biological markers cannot replace (1)H-MR spectroscopy for the assessment of liver fat in this population. (1) H-MR spectrosopy can reliably estimate the weight fraction of liver steatosis. Type-2 diabetes provides an interesting model for assessing liver steatosis. Clinico-biological markers seem to be invalid predictors for steatosis in type-2 diabetes.

Performance of the digene LQ, RH and PS HPVs genotyping systems on clinical samples and comparison with HC2 and PCR-based Linear Array

BackgroundCertain Human Papillomaviruses (HPVs) are the infectious agents involved in cervical cancer development. Detection of HPVs DNA is part of the cervical cancer screening protocols and HPVs genotyping has been proposed for its inclusion in these preventive programs. The aim of this study was to evaluate three novel genotyping tests, namely Qiagen LQ, RH and PS, in clinical samples with and without abnormalities. For this, 305 cervical samples were processed and the results of the evaluated techniques were compared with those obtained in the HPVs diagnostic process in our lab, by using HC2 and Linear Array (LA) technologies.ResultsThe concordances and kappa statistics (k) for each technique compared with HC2 were 98.69% (k = 0.94) for LQ, 98.03% (k = 0.91) for RH and 91.80% (k = 0.82) for PS. There was a very good agreement in HPVs type-specific concordance for the most prevalent types HPV16 (kappa range = 0.83-0.90), HPV18 (k.r.= 0.74-0.80) and HPV45 (k.r.= 0.82-0.90).ConclusionsThe three tests showed an overall good concordance for HPVs detection when compared with HR-HC2 system. LQ and RH rendered lower detection rate for multiple infections than LA genotyping. However, our understanding of the clinical significance of multiple HPVs infections is still incomplete and therefore the relevance of the lower ability to detect multiple infections needs to be evaluated.

Concordance of Physician Ratings With the Appropriate Use Criteria for Coronary Revascularization

The objective of this study was to compare the consistency in appropriate use criteria (AUC) ratings among a broad range of practicing cardiologists and the AUC Technical Panel. AUC for coronary revascularization have been developed by selected experts. Before AUC publication, 85 cardiologists from 10 U.S. institutions assessed the appropriateness of coronary revascularization for 68 indications that had been evaluated by the AUC Technical Panel. Each indication was classified as appropriate, uncertain, or inappropriate, based on the physician group's median rating. Rates of concordance between the physician group and the AUC Technical Panel (i.e., same appropriateness category assignment) and rates of nonagreement within the physician group (≥ 25% of panelists' ratings outside the group's appropriateness category assessment) were determined. Overall concordance between the 2 groups was 84%. Among indications classified as appropriate by the AUC Technical Panel, concordance between the 2 groups was excellent (94% [34 of 36]); however, nonagreement within the physician group was 44% (16 of 36). Among indications classified as uncertain, there was 73% (16 of 22) concordance between the 2 groups. Among inappropriate indications, concordance was moderate (70% [7 of 10]), but nonagreement occurred frequently (70% [7 of 10]). Moreover, there was substantial variation in appropriateness ratings between individual physicians and the AUC Technical Panel (weighted kappa range: 0.05 to 0.76). Although there was good concordance in assessments of appropriateness for coronary revascularization between physicians and the AUC Technical Panel, nonagreement within the physician group was common and there was marked variation in ratings between individual physicians and the AUC Technical Panel.

Reliability and validity of the Safe Routes to school parent and student surveys

BackgroundThe purpose of this study is to assess the reliability and validity of the U.S. National Center for Safe Routes to School's in-class student travel tallies and written parent surveys. Over 65,000 tallies and 374,000 parent surveys have been completed, but no published studies have examined their measurement properties.MethodsStudents and parents from two Charlotte, NC (USA) elementary schools participated. Tallies were conducted on two consecutive days using a hand-raising protocol; on day two students were also asked to recall the previous days' travel. The recall from day two was compared with day one to assess 24-hour test-retest reliability. Convergent validity was assessed by comparing parent-reports of students' travel mode with student-reports of travel mode. Two-week test-retest reliability of the parent survey was assessed by comparing within-parent responses. Reliability and validity were assessed using kappa statistics.ResultsA total of 542 students participated in the in-class student travel tally reliability assessment and 262 parent-student dyads participated in the validity assessment. Reliability was high for travel to and from school (kappa > 0.8); convergent validity was lower but still high (kappa > 0.75). There were no differences by student grade level. Two-week test-retest reliability of the parent survey (n = 112) ranged from moderate to very high for objective questions on travel mode and travel times (kappa range: 0.62 - 0.97) but was substantially lower for subjective assessments of barriers to walking to school (kappa range: 0.31 - 0.76).ConclusionsThe student in-class student travel tally exhibited high reliability and validity at all elementary grades. The parent survey had high reliability on questions related to student travel mode, but lower reliability for attitudinal questions identifying barriers to walking to school. Parent survey design should be improved so that responses clearly indicate issues that influence parental decision making in regards to their children's mode of travel to school.

Inter-rater reliability of the Early Functional Abilities scale

To investigate the inter-rater reliability of the Early Functional Abilities (EFA) scale. An observational study of inter-rater reliability in an open cohort. Twenty-four patients with traumatic brain injury in need of medical or surgical intervention in the early rehabilitation section of the intensive care unit. The EFA was assessed by 4 different professions in the rehabilitation team. Inter-rater reliability was assessed using linear weighted kappa statistics. The overall weighted kappa values of the different EFA items varied from 0.27 to 0.60. The items in the sensorimotor functional area had the highest pairwise agreement,with a mean kappa range of 0.68–0.76. The vegetativest ability, position tolerance and wakefulness items had the lowest mean kappa values (0.49, 0.33 and 0.49, respectively). Agreement was good to excellent between the occupational therapist and physiotherapist across the majority of the items, whereas the physician and nurse agreed less with one another. The inter-rater reliability of the EFA scale was good for most items among all the raters. The scale maybe used by all members of the interdisciplinary team after training in administration and scoring. A reduction in the number of items in the vegetative functional domain is recommended.

312: Derivation of a Decision Instrument for Selective Chest Radiography In Blunt Trauma

To derive a clinical decision instrument (DI) for selective chest imaging in blunt trauma that identifies patients who have virtually no risk of significant intrathoracic injury (SITI) and therefore no need for radiography. At three Level One trauma centers, physicians caring for blunt trauma patients over age 14 years were asked to record the presence or absence of 12 clinical criteria prior to viewing CXR results. SITI was defined as pneumothorax, hemothorax, aortic/great vessel injury, two or more rib fractures, ruptured diaphragm, sternal fracture and pulmonary contusion on official radiograph readings. Kappa (inter-rater reliability) and screening performance of individual criteria were determined. Using recursive partitioning, the most highly sensitive combination of criteria for SITI was derived as the DI. Of the 2,628 subjects enrolled, 271 (10.3%) were diagnosed with a total of 462 SITIs, with rib fractures (73%), pneumothorax (38%) and pulmonary contusion (29%) as the most common injuries. Chest pain and chest wall tenderness had the highest sensitivity for SITI (65%). The DI of chest pain, distracting injury, chest wall tenderness, intoxication, age > 60, rapid deceleration and altered alertness/mental status had the following screening performance: sensitivity 99.3% (95% CI: 97.4-99.8%), specificity 14.0% (95% CI: 12.6- 15.4%), negative predictive value 99.4% (95% CI: 97.8- 99.8%), and positive predictive value 11.7% (95% CI: 10.5 - 13.1%). All 7 criteria in the DI met the predetermined cut-off for acceptable kappa (range 0.51-0.81). We derived a DI consisting of 7 clinical criteria that can identify SITI in blunt trauma patients with extremely high sensitivity. If validated, this instrument will allow for safe, selective chest imaging with potential resource savings.