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The inter-observer agreement of examining pre-school children with acute cough: a nested study
Alastair D Hay1, Andrew Wilson, Tom Fahey
1Division of Primary Health Care, University of Bristol, Cotham House, Cotham Hill, Bristol, BS6, 6JL, UK. alastair.hay@bristol.ac.uk
Insights
Clinical signs in pre-school children with cough show poor agreement among primary care clinicians. This unreliability impacts diagnosis, prognosis, and treatment decisions, highlighting a need for improved assessment methods.
Area of Science:
- Pediatrics
- Primary Care Medicine
- Clinical Diagnostics
Background:
- Clinical signs are crucial for diagnosis, prognosis, and treatment planning in pediatric primary care.
- Assessing the reliability of clinical sign interpretation is essential for accurate patient management.
- Pre-school children with acute cough frequently present to primary care settings.
Purpose of the Study:
- To evaluate the inter-observer agreement of clinical sign assessments in pre-school children with acute cough.
- To determine the reliability of specific clinical signs, including tachypnoea, chest signs, and fever, in primary care evaluations.
- To inform clinical practice regarding the diagnostic utility of observed signs in young children.
Main Methods:
- A nested study design was employed within a prospective cohort of 256 pre-school children presenting with acute cough.
- Two distinct clinical assessment methods (unstandardised and standardised) were compared.
- Inter-observer agreement was quantified using kappa statistics for tachypnoea, chest signs, and fever.
Main Results:
- Kappa statistics indicated poor to fair agreement for all assessed clinical signs, with values ranging from 0.12 to 0.39.
- Chest signs demonstrated the highest level of inter-observer reliability among the evaluated clinical indicators.
- The findings suggest significant variability in the interpretation of clinical signs by primary care practitioners.
Conclusions:
- Primary care clinicians must recognize the potential unreliability of clinical signs when managing pre-school children with cough.
- The variability in sign interpretation can affect critical decisions regarding diagnosis, prognosis, and treatment.
- Further research is necessary to develop and validate more robust methods for identifying and interpreting abnormal clinical signs in this pediatric population.
Background:
The presence of clinical signs have implications for diagnosis, prognosis and treatment. Therefore, the aim of this study was to examine the inter-observer agreement of clinical signs in pre-school children presenting to primary care.
Methods:
A nested study comparing two clinical assessments within a prospective cohort of 256 pre-school children with acute cough recruited from eight general practices in Leicestershire, UK. We examined agreement (using kappa statistics) between unstandardised and standardised clinical assessments of tachypnoea, chest signs and fever.
Results:
Kappa values were poor or fair for all clinical signs (range 0.12 to 0.39) with chest signs the most reliable.
Conclusions:
Primary care clinicians should be aware that clinical signs may be unreliable when making diagnosis, prognosis and treatment decisions in pre-school children with cough. Future research should aim to further our understanding of how best to identify abnormal clinical signs.
