Interobserver variability of croup scoring in clinical practice.

Area of Science:

• Pediatric Emergency Medicine
• Respiratory Medicine
• Clinical Assessment and Diagnostics

Background:

• Viral laryngotracheobronchitis (croup) is a common cause of upper airway obstruction in young children.
• Current clinical assessment often relies on croup scores, but these lack validation in real-world clinical settings.

Purpose of the Study:

• To evaluate the reliability of clinical observation items used in croup scoring systems within a pediatric emergency department (ED).

Main Methods:

• A literature review identified 10 key observation variables for croup assessment.
• A prospective cohort study involving 158 children (3 months to 5 years) with croup was conducted over 13 months.
• Interobserver agreement among triage nurses and ED physicians was analyzed using Cohen's quadratic weighted kappa.

Main Results:

• Interobserver agreement for all clinical observation items was statistically significant but ranged from fair to moderate (kappa values 0.2–0.6).
• The study assessed 158 children with croup, with observations made by three independent healthcare providers before treatment.

Conclusions:

• Significant interobserver variability exists in assessing respiratory signs of croup among healthcare providers in busy pediatric EDs.
• Stridor and retractions emerged as the most reliable clinical indicators for croup assessment based on this study and prior research.