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Interobserver variability in assessing pediatric postextubation stridor
K J Kemper1, M S Benson, M J Bishop
1Department of Pediatrics, University of Washington, Seattle.
Insights
Assessing pediatric postextubation upper airway distress shows variable reliability among healthcare providers. Improved interobserver agreement is needed for consistent management of critically ill children.
Area of Science:
- Pediatric critical care medicine
- Respiratory physiology
- Clinical assessment reliability
Background:
- Assessing pediatric postextubation upper respiratory distress is crucial for timely intervention.
- The interobserver reliability of commonly used parameters for this assessment is not well-established.
Purpose of the Study:
- To prospectively evaluate the interobserver reliability of six parameters used to assess pediatric postextubation upper respiratory distress.
- To identify parameters with consistent reliability for improved clinical decision-making.
Main Methods:
- Prospective study involving 25 children (<15 years) hospitalized for traumatic injuries.
- Independent assessment of respiratory rate, stridor, air movement, flaring/retractions, level of consciousness, and oxygen saturation by a physician, nurse, and respiratory therapist at extubation.
- Reliability measured using percentage agreement and weighted kappa (Kw).
Main Results:
- Percentage agreement ranged from 82% (air movement) to 96% (oxygen saturation).
- Weighted kappas indicated excellent reliability for respiratory rate and flaring/retractions (Kw > 0.6).
- Moderate reliability was found for level of consciousness, stridor, and oxygen saturation (0.4 < Kw < 0.6), while air movement showed poor reliability (Kw < 0.4).
Conclusions:
- Significant variability exists in the interobserver reliability of several parameters used to assess pediatric postextubation upper respiratory distress.
- Further standardization and training are necessary to enhance agreement among clinicians for more consistent airway management.
- Improving interobserver agreement is essential for optimizing care in critically ill children experiencing respiratory distress.
Abstract:
The reliability of parameters used to assess pediatric postextubation upper respiratory distress is unknown. We prospectively studied the interobserver reliability of six parameters commonly used to assess respiratory distress in children. Eligible patients were less than 15 years old and hospitalized for traumatic injuries at Harborview Medical Center between March and September 1989. At extubation, patients were examined independently by a physician, a nurse, and a respiratory therapist, each of whom evaluated respiratory rate (RR), stridor, air movement, flaring/retractions (F/R), level of consciousness (LOC), and oxygen saturation (O2 sat). Reliability was measured by percentage agreement and weighted kappa (Kw). The 25 children (27 extubations) had a median age of 7 years, and eight of the 27 required treatment for upper airway obstruction. Percentage agreement ranged from 82% (for air movement) to 96% (for O2 sat). Weighted kappas were excellent for RR and F/R (Kw greater than .6); moderate for LOC, stridor, and O2 sat (0.4 less than Kw less than .06); and poor for air movement (Kw less than .4). Further improvements in interobserver agreement are required to provide more consistent upper airway management in critically ill children.