Single-measure Intraclass Correlation Research Articles

Triple Jump Examinations for Dental Student Assessment

The triple jump examination (TJE) attempts to assess a higher level of learning with demand for analysis, critical thinking, and resolution of problems presented by written scenarios based on patient care situations. The purpose of this study was to examine the internal consistency, scale reliability, and interrater reliability of the TJE used at the Ostrow School of Dentistry, University of Southern California. On the sample of 2,227 examinations administered by seventy-seven raters across a three-year time period, the Cronbach's coefficient alpha for internal consistency of the overall TJE was found to be good (a=0.869). The internal consistency of the three subscales was found to be acceptable (a=0.731), good (a=0.820), and good (a=0.820). Average and single measures intraclass correlation coefficients (ICC) for scale reliability were significant at p<0.001, indicating strong interrater reliability. There were no statistically significant differences (p≤0.05) in the mean scores assigned on the TJE between rater groups defined by rater experience level with the TJE. A very high level of agreement among rater pairs was also observed. Across the entire three-year study period, with over 19,152 ratings, the seventy-seven raters were in general agreement 99.5 percent of the time and in exact agreement 77.2 percent of the time.

Measurement of the aortic annulus diameter using transesophageal echocardiography and multislice computed tomography. Are they interchangeable?

Background: Transesophageal echocardiography (TEE) is often considered as the reference method for the measurement of the aortic annulus diameter (AAD) during transcatheter aortic valve implantation (TAVI). In the present study, we evaluated whether Multislice Computed Tomography (MSCT) could reproduce and thus substitute to TEE. Method: We compared AAD measurements performed using TEE, MSCT and transthoracic echocardiography (TTE) in 129 consecutive patients with severe aortic stenosis (AS) referred for TAVI. Using MSCT, AAD was measured in the 3-chamber view and at the level of the virtual basal ring. We calculated the mean (MD) of the long-axis (LA) and short-axis (SA) diameters, mathematic transformations emphasizing the weight of the SA (MD2 to MD5, MD2 = 2SA + LA/3 ...), AAD derived from the cross-sectional area and from the circumference of the virtual basal ring. Comparisons between methods were assessed using single-measure intraclass correlation coefficient (ICC) and agreements as regard to the TAVI strategy (decision to implant and choice of the prosthesis' size based on manufacturer's cutoffs recommendations) expressed using the kappa value. Results: The 3C method (ICC=0.79, 95% interval 0.73-0.83), MD4 (ICC=0.76, 95% interval 0.69-0.81) and MD5 (ICC=0.75, 95% interval 0.67-0.81) provided the highest correlation and the best agreement to TEE (kappa value of 0.47, 0.27 and 031 respectively) but remained lower than TTE (ICC=0.87; 95% interval 0.83-0.91; kappa=0.66). The agreement between MSCT and TEE varied with the degree of eccentricity of the aortic annulus or the degree of aortic valve calcification but never reached the values observed with TTE. Conclusion: No direct or indirect MSCT method provided higher correlations to TEE than TTE. Consequently, no MSCT method could reproduce and thus substitute to TEE. Randomized prospective studies are clearly needed to evaluate which method provides the best clinical results, but we definitely demonstrate that MSCT and TEE are not interchangeable.

The Managing Emergencies in Paediatric Anaesthesia global rating scale is a reliable tool for simulation‐based assessment in pediatric anesthesia crisis management

The use of simulation-based assessments for high-stakes physician examinations remains controversial. The Managing Emergencies in Paediatric Anaesthesia course uses simulation to teach evidence-based management of anesthesia crises to trainee anesthetists in the United Kingdom (UK) and Canada. In this study, we investigated the feasibility and reliability of custom-designed scenario-specific performance checklists and a global rating scale (GRS) assessing readiness for independent practice. After research ethics board approval, subjects were videoed managing simulated pediatric anesthesia crises in a single Canadian teaching hospital. Each subject was randomized to two of six different scenarios. All 60 scenarios were subsequently rated by four blinded raters (two in the UK, two in Canada) using the checklists and GRS. The actual and predicted reliability of the tools was calculated for different numbers of raters using the intraclass correlation coefficient (ICC) and the Spearman-Brown prophecy formula. Average measures ICCs ranged from 'substantial' to 'near perfect' (P≤0.001). The reliability of the checklists and the GRS was similar. Single measures ICCs showed more variability than average measures ICC. At least two raters would be required to achieve acceptable reliability. We have established the reliability of a GRS to assess the management of simulated crisis scenarios in pediatric anesthesia, and this tool is feasible within the setting of a research study. The global rating scale allows raters to make a judgement regarding a participant's readiness for independent practice. These tools may be used in the future research examining simulation-based assessment.

SAT0509 Three-Dimensional Versus Two-Dimensional Ultrasonography in the Assessment of Peripheral Enthesitis in Spondylarthritis

BackgroundPower Doppler ultrasonography (PdUS) is widely used for the evaluation of the entheses in spondylarthritis (SpA). PdUS has been shown to be useful for the diagnosis and the evaluation of...

“GIOSAT”: a tool to assess CanMEDS competencies during simulated crises

Our objective was to develop and evaluate a Generic Integrated Objective Structured Assessment Tool (GIOSAT) to integrate Medical Expert and intrinsic (non-medical expert) CanMEDS competencies with non-technical skills for crisis simulation. An assessment tool was designed and piloted using two pediatric anesthesia scenarios (laryngospasm and hyperkalemia). Following revision of the tool, we used previously recorded videos of anesthesia residents (n=50) who managed one of two intraoperative advanced cardiac life support (ACLS) scenarios (ventricular tachycardia or ventricular fibrillation). Four independent trained raters, blinded to the residents' level of training, analyzed the video recordings using the GIOSAT scale. Inter-rater reliability was calculated using intraclass correlations (ICCs) for single raters (single measure) and the average of the four raters (average measure), and construct validity was investigated by correlating GIOSAT scores with postgraduate year of residency (PGY). Total GIOSAT scores for the ACLS scenarios had single measure ICCs of 0.62 and average measure ICCs of 0.85. Inter-rater reliability was substantial for both Medical Expert and intrinsic competencies (single measure ICCs 0.69 and 0.62, respectively; average measure ICCs 0.90 and 0.82, respectively). We found significant correlations between PGY level and total GIOSAT score (r=0.36; P=0.011) and between PGY level and Medical Expert competencies (r=0.42; P=0.003); however, correlations were not found between PGY level and intrinsic CanMEDS competencies (r=0.24; P=0.09). Inter-rater reliability of the total GIOSAT scores using four trained raters was substantial. Significant correlation between PGY and (i) total GIOSAT score and (ii) Medical Expert competencies supports construct validity. Evidence of validity was not obtained for intrinsic CanMEDS competencies.

Objective Color Measurements

Color measurements are an essential part of scar evaluation. Thus, vascularization (erythema) and pigmentation (melanin) are common outcome parameters in scar research. The aim of this study was to investigate the clinimetric properties and clinical feasibility of the Mexameter, Colorimeter, and the DSM II ColorMeter for objective measurements on skin and scars. Fifty scars with a mean age of 6 years (2 months to 53 years) were included. Reliability was tested using the single-measure interobserver intraclass correlation coefficient. Validity was determined by measuring the Pearson correlation with the Fitzpatrick skin type classification (for skin) and the Patient and Observer Scar Assessment Scale (for scar tissue). All three instruments provided reliable readings (intraclass correlation coefficient ≥ 0.83; confidence interval: 0.71-0.90) on normal skin and scar tissue. Parameters with the highest correlations with the Fitzpatrick classification were melanin (Mexameter), 0.72; ITA (Colorimeter), -0.74; and melanin (DSM II), 0.70. On scars, the highest correlations with the Patient and Observer Scar Assessment Scale vascularization scores were the following: erythema (Mexameter), 0.59; LAB2 (Colorimeter), 0.69; and erythema (DSM II), 0.66. For hyperpigmentation, the highest correlations were melanin (Mexameter), 0.75; ITA (Colorimeter), -0.80; and melanin (DSM II), 0.83. This study shows that all three instruments can provide reliable color data on skin and scars with a single measurement. The authors also demonstrated that they can assist in objective skin type classification. For scar assessment, the most valid parameters in each instrument were identified.

Inter- and Intraobserver Reliability of the Radiographic Diagnosis and Treatment of Acromioclavicular Joint Separations

The management of acromioclavicular joint separations, in particular Rockwood types III and V, remains controversial. The purpose of this study was to investigate the observer reliability of shoulder surgeons when presented with the same cases of acromioclavicular joint separations. The authors retrospectively identified 28 patients who were diagnosed with a type III, IV, or V acromioclavicular joint separation. A PowerPoint presentation was compiled that contained an anteroposterior and axial radiograph from each patient prior to treatment. Radiographs were sent to surgeons, who diagnosed each injury according to the Rockwood classification and stated whether they recommended operative or nonoperative treatment for each patient.Inter- and intraobserver reliability were calculated from the surgeons' reviews. Repeat diagnoses were returned by 8 surgeons. A single-measure intraclass correlation coefficient (ICC) was used to determine interobserver reliability for the surgeons' Rockwood classifications (ICC=0.602) and their decision to operate (ICC=0.469). Intraobserver reliability also was calculated for Rockwood classifications (ρ=0.694) and decision to operate (κ=0.366). Two (25%) of 8 surgeons stated that they would have used open and arthroscopic techniques for repairing the dislocations, whereas the remaining (75%) surgeons would have performed open techniques. Individual surgeons were consistent in their grading of acromioclavicular joint dislocations, but less observer agreement existed among the surgeons. Poor agreement among surgeons for the decision to operate indicates that this decision is heavily influenced by clinical factors and the radiographic classification.

Validity of the Nintendo Wii® balance board for the assessment of standing balance in Parkinson’s disease

Background: Impaired postural stability places individuals with Parkinson’s at an increased risk for falls. Given the high incidence of fall-related injuries within this population, ongoing assessment of postural stability is important. Objective: To evaluate the validity of the Nintendo Wii® balance board as a measurement tool for the assessment of postural stability in individuals with Parkinson’s. Subjects: Twenty individuals with Parkinson’s participated. Intervention: Subjects completed testing on two balance tasks with eyes open and closed on a Wii® balance board and biomechanical force platform. Main Measures: Bland–Altman plots and a two-way, random-effects, single measure intraclass correlation coefficient model were used to assess concurrent validity of centre-of-pressure data. Results: Concurrent validity was demonstrated to be excellent across balance tasks (intraclass correlation coefficients = 0.96, 0.98, 0.92, 0.94). Conclusions: This study suggests that the Wii® balance board is a valid tool for the quantification of postural stability among individuals with Parkinson’s.

Relation between Beat‐to‐Beat QT Interval Variability and T‐Wave Amplitude in Healthy Subjects

Elevated beat-to-beat QT interval variability (QTV) has been associated with increased cardiovascular morbidity and mortality.The aim of this study was to investigate interlead differences in beat-to-beat QTV of 12-lead ECG and its relationship with the T wave amplitude. Short-term 12-lead ECGs of 72 healthy subjects (17 f, 38 ± 14 years; 55 m, 39 ± 13 years) were studied. Beat-to-beat QT intervals were extracted separately for each lead using a template matching algorithm. We calculated the standard deviation of beat-to-beat QT intervals as a marker of QTV as well as interlead correlation coefficients. In addition, we measured the median T-wave amplitude in each lead. There was a significant difference in the standard deviation of beat-to-beat QT intervals between leads (minimum: lead V(3) (2.58 ± 1.36 ms), maximum: lead III (7.2 ± 6.4 ms), ANOVA: P < 0.0001). Single measure intraclass correlation coefficients of beat-to-beat QT intervals were 0.27 ± 0.18. Interlead correlation coefficients varied between 0.08 ± 0.33 for lead III and lead V(1) and 0.88 ± 0.09 for lead II and lead aVR. QTV was negatively correlated with the T-wave amplitude (r =-0.62, P < 0.0001). There was no significant affect of mean heart rate, age or gender on QT variability (ANOVA: P > 0.05). QTV varies considerably between leads in magnitude as well as temporal patterns. QTV is increased when the T wave is small.

Novel grading system for pupillary ruff changes and associated features

To evaluate the reproducibility of a new system for grading pupil ruff changes and associated findings. Observational comparative study. Forty-seven photograph sets including iris, pupil edge and ruff, and inferior anterior chamber drainage angle. A novel system for recording pupillary ruff changes was developed, along with reference iris, pupil and gonioscopy images. A prospective masked agreement study was undertaken using two observers who graded the photograph sets using this new system. Parameters included pupillary ruff absence and abnormality, pupil edge pigment, trabecular meshwork pigment, Sampaolesi line pigment, iris root pigment, and pigment 'lumps' and 'piles'. Intraobserver and interobserver agreement for the parameters of the grading system, assessed with the intraclass correlation coefficient and Bland-Altman plots. Photographs of 47 eyes of 47 glaucoma suspects and glaucoma patients were evaluated. Agreement percentages of ≥95% (average 96%) and ≥60% (average 70%) were obtained for intraobserver and interobserver agreement, respectively. The average interobserver single-measure intraclass correlation coefficient and repeat-measures intraclass correlation coefficient were 0.75 (range 0.54-0.88) and 0.85 (range 0.70-0.94), respectively. There was a non-significant trend towards interobserver systematic bias on one of the nine parameters (iris stroma pigment at the pupil edge). This grading system provides a reliable and reproducible system for encoding of clinical signs of pupil ruff atrophy for clinical research.

Reliability of knee joint muscle activity during weight bearing force control

We developed a novel approach that requires subjects to produce and finely tune ground reaction forces (GRFs) while standing. The aim of this study was to examine the reliability of electromyographic data recorded during these tasks. Healthy young adults stood with their dominant leg in a boot fixed to a force platform. A target matching protocol required subjects to control both the direction and magnitude of GRF along the horizontal plane while maintaining constant inferior–superior loads of 50% body-weight (BW). Each target matching task was repeated three times in a random order. Subjects were retested with the same protocol 2–3days later. Normalised electromyography data of eight muscles crossing the knee joint was collected for each successful target match. A random model, single measures intra-class correlation analysed the reliability for both test–retest and intra-day results, in addition to inter-subject reliability. The GRFs required to meet the targets were comparable to a range of activities of daily living, ranging from 0.48 to 0.58N/kg of BW in the horizontal plane while maintaining 50% BW in the vertical plane. We observed moderate to high ICC values (0.60–0.993) for most muscles in most directions, indicating low within-subject variance. In addition, moderate to high between-subject reliability was observed in all eight muscle activation profiles, indicating subjects used similar neuromuscular control strategies to achieve the desired GRFs. In conclusion, our protocol identifies non-random weight-bearing motor control strategies while generating direction dependent GRFs. These results provide reliable insight into knee joint stabilisation strategies during weight bearing.

INTEGRATED NEUROCOGNITIVE THERAPY (INT): HOW DOES THE INTEGRATION OF AUTOMATIC AND CONTROLLED APPROACHES WORK?

Brief assessments have the potential to be widely adopted as outcome measures in research but also routine clinical practice. Existing brief rating scales that assess symptoms of schizophrenia or psychosis have a number of limitations including inability to capture five symptom domains of psychosis and a lack of clearly defined operational anchor points for scoring.We developed a new brief rating scale for five symptom domains of psychosis with clearly defined operational anchor points – the Brief Evaluation of Psychosis Symptom Domains (BE-PSD). To examine the psychometric properties of the BE-PSD, fifty patients with schizophrenia or schizoaffective disorder were included in this preliminary cross-sectional study. To test the convergent and discriminant validity of the BE-PSD, correlational analyses were employed using the consensus Positive and Negative Syndrome Scale (PANSS) five-factor model. To examine the inter-rater reliability of the BE-PSD, single measures intraclass correlation coefficients (ICCs) were calculated for 11 patients.The BE-PSD domain scores demonstrated high convergent validity with the corresponding PANSS factor score (rs = 0.81–0.93) as well as good discriminant validity, as evidenced by lower correlations with the other PANSS factors (rs = 0.23–0.62). The BE-PSD also demonstrated excellent inter-rater reliability for each of the domain scores and the total scores (ICC(2,1) = 0.79–0.96).The present preliminary study found the BE-PSD measure to be valid and reliable; however, further studies are needed to establish the psychometric properties of the BE-PSD because of the limitations such as the small sample size and lacking data on test-retest reliability or sensitivity to change.

Intraclass correlation in practice: Assessment of reliability of manual blood pressure measurement among assessors in a clinical trial

Background : To ensure the reliability of manual blood pressure (BP) readings in a clinical trial, sources of error due to measurement must be reduced as much as possible. Apart from following standard procedure for BP measurement and ensuring good equipments, the measurement errors that come from the assessors themselves should be assessed. Objective : To demonstrate the use of two-way random effects, interactions absent, absolute agreement (Type A), single measures (Type 1) intraclass correlation coefficient (ICC) in the assessment of reliability of manual BP readings among assessors involved in a clinical trial using manual BP measurement, by using an interrater reliability study conducted by the authors as an example study. Methods : The steps involved in obtaining ICC in the study were discussed. Sample size given the number of assessors in the study was calculated. BP was measured using regularly maintained mercury sphygnomanometers, following recommendations by Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) for BP measurement in office setting. The outcomes were systolic and diastolic BP readings. A type of ICC, two-way random effects, interactions absent, absolute agreement (Type A), single measures (Type 1) ICC was chosen for the analysis and specifically discussed. Pre-requisite assumptions for ICC were meticulously checked and described. The interrater reliability for systolic and diastolic BP readings as expressed by ICC (single measure) were presented with confidence interval (CI). The ICCs obtained in the example study were discussed and concluded. The flaws of the study were also criticised. Results : The interrater reliability for systolic and diastolic BP measurements as expressed by ICC (single measure) were 0.87 (95% confidence interval [CI] 0.722, 0.956) and 0.77 (95% CI 0.560, 0.918) respectively. Conclusion : We demonstrated the steps required to obtain ICC. Since the use of manual BP measurement using mercury sphygmomanometer is still considered as gold standard of BP measurement, it is important that studies in which the BP outcome is measured using such method conduct interrater reliability studies properly.

Variability in the Calibration Error of the Goldmann Applanation Tonometer

To investigate the variability in the measured calibration error with continued usage of Goldmann applanation tonometers (GATs) having unacceptable calibration error. The study included 132 slit-lamp mounted Goldmann tonometers (Model AT 900 C/M; Haag-Streit, Switzerland). A single observer twice checked a randomly selected set of 25 instruments on 2 consecutive days to determine the intraobserver agreement in the measurement of GAT calibration error. The same observer prospectively checked all the instruments between 8 and 9 AM on any given day at all testing levels namely 0, 20, and 60 mm Hg and rechecked the faulty instruments (calibration error more than ± 2 mm Hg at any testing level) 2 times more on the same day between 12 noon and 1 PM and 4 and 5 PM. The single measures intraclass correlation coefficients for the intraobserver agreement at the 20 mm Hg testing level were 0.78 for positive error and 0.83 for negative error. Twenty-eight (21%) instruments were faulty at any testing level. Nineteen (14%) were faulty at the clinically most important 20 mm Hg testing level. The maximum observed variability in the positive and negative calibration error at any testing level was +4 and -23 mm Hg, respectively. Fifteen (53%) faulty instruments had high variability (≥ 2 mm Hg) in the calibration error at any testing level. The calibration error of faulty GATs can frequently have a high variability. One should avoid estimating the true intraocular pressure from a faulty GAT by instinct.

Measurement of hepatic venous pressure gradient revisited: Catheter wedge vs balloon wedge techniques

Aims:To evaluate the accuracy of measurement of hepatic venous pressure gradient by catheter wedge as compared to balloon wedge (the gold standard).Materials and Methods:Forty-five patients having a clinical diagnosis of intrahepatic portal hypertension were subjected to the two different types of pressure measurements (catheter wedge and balloon wedge) during transjugular liver biopsy under fluoroscopic guidance.Statistical Analysis:Spearman's rank correlation coefficient, Bland–Altman plot for agreement, and single measure intraclass correlation were used for analysis of data.Results:There was a close correlation between the results obtained by both the techniques, with highly significant concordance (P < 0.0001). Hepatic venous pressure gradients as measured by the catheter wedge technique were either equal to or less than those obtained by the balloon wedge technique.Conclusions:The difference in hepatic venous pressure gradients measured by the two techniques is insignificant.

Intra‐ and inter‐rater reliability for analysis of hyoid displacement measured with sonography

Anterior hyoid displacement is essential for efficient swallowing and is usually investigated with videofluoroscopy. Ultrasound offers a less expensive and noninvasive method of investigation. The present study investigated the viability of a novel method of quantifying hyoid displacement from sonograms using an anatomic reference point, through an evaluation of inter- and intra-rater reliability. Three raters reviewed the sonographic video sweeps of five discrete swallows from each of five participants for inter-rater reliability. The primary investigator measured each swallow on two occasions for intra-rater reliability. Electronic calipers were used to measure distances from a "rest" frame prior to the swallow of interest and a "maximal displacement" frame, at which the hyoid bone was at maximal anterior displacement during each swallow. Single-measure intraclass correlation coefficient was high for inter-rater agreement at 0.86 for rest measures and 0.86 for maximal displacement. Intra-rater reliability was even higher at 0.95 for rest and 0.98 for maximal displacement. These preliminary results suggest that by using a novel analysis approach involving an anatomic reference point, raters can achieve high agreement on measurement of position of hyoid at maximal displacement relative to rest.

Accuracy of endoscopic ultrasound elastography used for differential diagnosis of focal pancreatic masses: a multicenter study

Endoscopic ultrasound (EUS) elastography represents a new imaging procedure that might characterize the differences of hardness and strain between diseased tissue and normal tissue. The aim of this study was to assess the efficiency of EUS elastography for the differentiation of focal masses in chronic pancreatitis and pancreatic cancer. The study group comprised 258 patients with focal pancreatic masses included prospectively at 13 participating centers. Qualitative analysis of the diagnoses made by two expert doctors using all recorded video clips was performed in order to test the interobserver variability. A post-processing software analysis was used to examine the EUS elastography videos by calculating average-hue histograms of individual elastography images. The quantitative information was used to calculate intra-observer variability and the accuracy of the method. Qualitative analysis of the recorded videos revealed a kappa value of 0.72. Intra-observer variability analysis revealed that the single measure intraclass correlation ranged between 0.86 and 0.94. The average-hue histogram analysis of the data indicated a sensitivity of 93.4 %, a specificity of 66.0 %, a positive predictive value of 92.5 %, a negative predictive value of 68.9 %, and an overall accuracy of 85.4 %, based on a cut-off value of 175. Area under the receiver operating characteristic curve (AUROC) was 0.854 ( P < 0.0001) with a confidence interval of 0.804 - 0.894. The value of quantitative analysis of EUS elastography recordings was proven by good reproducibility of the videos, as well as good parameters of the AUROC analysis. (Clinical Trials.gov identifier: CT00909103).

Test–retest assessment of independent component analysis-derived resting-state functional connectivity based on functional near-infrared spectroscopy

Recent studies of resting-state functional near-infrared spectroscopy (fNIRS) have emerged as a hot topic and revealed that resting-state functional connectivity (RSFC) is an inherent characteristic of the resting brain. However, it is currently unclear if fNIRS-based RSFC is test–retest reliable. In this study, we utilized independent component analysis (ICA) as an effective RSFC detection tool to address the reliability question. Sixteen subjects participated in two resting-state fNIRS recording sessions held 1week (6.88±1.09days) apart. Then, RSFC in the sensorimotor regions was extracted using ICA. Test–retest reliability was assessed for intra- and inter-sessions, at both individual and group levels, and for different hemoglobin concentration signals. Our results clearly demonstrated that map-wise reliability was excellent at the group level (with Pearson's r coefficients up to 0.88) and generally fair at the individual level. Cluster-wise reliability was better at the group level (having reproducibility indices of up to 0.97 for the size and up to 0.80 for the location of the detected RSFC) and was weaker but still fair at the individual level (0.56 and 0.46 for intra- and inter-session reliabilities, respectively). Cluster-wise intra-class correlation coefficients (ICCs) also exhibited fair-to-good reliability (with single-measure ICC up to 0.56), while channel-wise single-measure ICCs indicated lower reliability. We conclude that fNIRS-based, ICA-derived RSFC is an essential and reliable biomarker at the individual and group levels if interpreted in map- and cluster-wise manners. Our results also suggested that channel-wise individual-level RSFC results should be interpreted with caution if no optode co-registration procedure had been conducted and indicated that “cluster” should be treated as a minimal analytical unit in further RSFC studies using fNIRS.

The readability of paediatric patient information materials: Are families satisfied with our handouts and brochures?

To determine the grade reading level of eight easily available patient handouts for parents of children with otitis media, to calculate the internal reliability and consistency of seven readability tests, and to explore the relationship between the grade reading level of a handout and parent satisfaction. Eight patient handouts developed for the parents of children with otitis media were collected, stripped of all formatting and analyzed using seven different readability formulas. Cronbach's alpha and intraclass correlation coefficients (ICC) were calculated to determine the internal reliability and consistency of the seven formulas. Parents were surveyed on their satisfaction with three of the handouts, and their responses were compared with the handouts' reading grade levels using ANOVA. Only four of the eight handouts had a mean grade 8 or less reading level. None of the handouts had a grade 5 or less reading level. Cronbach's alpha was calculated to be 0.990, single measures ICC 0.931 and average class ICC 0.990, indicating extremely high internal reliability/consistency among the different readability tests. One-way ANOVA showed no evidence of a significant difference in parental satisfaction with the three handouts tested, despite their different grade reading levels (grades 7, 10 and 14) (P=0.24). While many readability formulas are available, the high internal reliability/consistency among them indicates that only one formula needs to be used to assess readability (eg, the Flesch-Kincaid Grade Level formula). Because there was no difference in parental satisfaction among three patient handouts that had widely different grade reading levels, studies should explore whether writing patient information materials explicitly to achieve low grade reading level scores is a worthwhile strategy.

358: Test Characteristics of Various Techniques of Ultrasonography Assessment for Pulmonary Edema Using B-Lines

358: Test Characteristics of Various Techniques of Ultrasonography Assessment for Pulmonary Edema Using B-Lines