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Interexaminer agreement in physical examination for children with suspected soft tissue abscesses
Joan Elizabeth Giovanni1, Mary Denise Dowd, Chris Kennedy
1Division of Emergency Medical Services, The Children's Mercy Hospitals and Clinics, Kansas City, MO 64108, USA. gegiovanni@cmh.edu
Insights
Physical examination for pediatric soft tissue abscesses showed fair to moderate agreement among physicians. This suggests physical exam alone lacks precision for diagnosing these infections in children.
Area of Science:
- Pediatric Emergency Medicine
- Surgical Infections
- Diagnostic Accuracy
Background:
- Soft tissue abscesses are common in children presenting to emergency departments.
- Accurate physical examination is crucial for diagnosis and management.
- Variability in physical examination findings may impact diagnostic precision.
Purpose of the Study:
- To quantify interexaminer agreement for physical examination findings in children with suspected soft tissue abscesses.
- To assess agreement on the diagnosis of abscess and the decision for incision and drainage.
Main Methods:
- Prospective study in a pediatric emergency department.
- Independent physical examinations by two physicians for 105 children with suspected skin abscesses.
- Calculation of interrater agreement for seven physical examination findings, diagnosis, and treatment decision.
Main Results:
- Substantial agreement for erythema and lesion size; moderate agreement for drainage and tenderness.
- Fair agreement for fluctuance; poor agreement for warmth and no agreement for induration.
- Moderate agreement was found for diagnosing the lesion as an abscess and deciding on incision and drainage.
Conclusions:
- Physical examination findings for pediatric soft tissue abscesses demonstrate fair to moderate interexaminer agreement.
- The imprecision of physical examination highlights its limitations as a primary diagnostic tool.
- Future research should explore adjunctive diagnostic tools, like bedside ultrasonography, to improve management.
Objective:
This study aimed to measure interexaminer agreement for physical examination (PE) findings in children with a suspected soft tissue abscess.
Methods:
A prospective study was conducted from March 1 to July 31, 2007, at an urban, tertiary care children's hospital emergency department. Children presenting to the emergency department with a suspected local skin abscess were independently examined by 2 physicians. Interrater agreement of 7 PE findings for children with a suspected soft tissue abscess was assessed. Interrater agreement was calculated for the diagnosis of the lesion and decision to incise and drain.
Results:
A total of 105 paired observations were completed by a total of 27 physicians. The patients examined were aged 2 weeks to 18 years, with a mean age of 80 months. Lesions were most frequently encountered on the buttocks (38%). Incision and drainage was attempted in 75% of cases, with purulent material obtained in 92% of all attempts. Interrater agreement was substantial for erythema (κ = 0.66) and size of the lesion (intraclass correlation coefficient = 0.78), moderate for drainage (κ = 0.57) and tenderness (κ = 0.40), fair for fluctuance (κ = 0.35), and poor for warmth (κ = 0.15) and showed no agreement for induration (κ = -0.08). There was moderate agreement on diagnosing the lesion as an abscess (κ = 0.48) and determination if the lesion required incision and drainage (κ = 0.44).
Conclusions:
Interexaminer agreement of examination findings and diagnosis of an abscess was fair to moderate, implying a lack of precision of PE as the primary means for diagnosis. Future studies of diagnostic adjuncts, such as bedside ultrasonography, may lead to improved management of soft tissue infections in children.
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