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Interrater reliability study of cerebral palsy diagnosis, neurological subtype, and gross motor function
Elodie Sellier1, Veronka Horber, Ingeborg Krägeloh-Mann
1TIMC-Techniques de l'Ingénierie Médicale et de la Complexité- Université Joseph Fourier-Grenoble 1, Grenoble, France. esellier@chu-grenoble.fr
Insights
Interrater reliability for classifying children with cerebral palsy (CP) was excellent when using video assessments and substantial for written case studies. This supports consistent diagnostic practices for cerebral palsy registries.
Area of Science:
- Neurology
- Pediatrics
- Rehabilitation Medicine
Background:
- Accurate classification of cerebral palsy (CP) is crucial for effective management and resource allocation.
- Standardized diagnostic criteria and reliable assessment methods are essential for epidemiological studies and clinical registries.
Purpose of the Study:
- To determine the interrater reliability of diagnosing cerebral palsy (CP) and classifying its subtypes and severity.
- To assess the consistency of classification among healthcare professionals using different data formats (video vs. written vignettes).
Main Methods:
- Two studies were conducted involving pediatricians and other healthcare professionals from multiple countries.
- Participants evaluated video sequences and written vignettes of children to determine CP presence, neurological subtype (using the Surveillance of Cerebral Palsy in Europe classification), and gross motor function level (using the Gross Motor Function Classification System [GMFCS]).
- Interrater reliability was quantified using Kappa (κ) coefficients for categorical data and intraclass correlation coefficients (ICCs) for ordinal data.
Main Results:
- Excellent reliability (κ=1.00) was observed for diagnosing CP when participants viewed videos (Study 1).
- Substantial reliability (κ=0.73) was found for CP diagnosis using written vignettes (Study 2).
- High reliability was also achieved for classifying neurological subtypes (κ=0.85 in Study 1, κ=0.78 in Study 2) and GMFCS levels (ICC=0.88 in Study 1, ICC=0.80 in Study 2).
Conclusions:
- The study demonstrates high interrater reliability for classifying children with cerebral palsy, particularly when using video assessments.
- These findings support the use of standardized classification systems for improving consistency in CP diagnosis and registry data.
- Reliability was found to be substantial even when professionals relied solely on written case descriptions.
Aim:
To evaluate the interrater reliability of the inclusion in registries and classification of children with cerebral palsy (CP).
Method:
Two studies were conducted. In study 1, 12 paediatricians from 11 countries viewed video sequences of 12 children with or without CP (nine males, three females; median age 6y; range 2-16). In study 2, 19 professionals from eight countries participated in an online exercise. They had to classify the same children but based on written vignettes. All participants had to evaluate whether the child had CP, the neurological subtype (Surveillance of Cerebral Palsy in Europe classification system), and gross motor function level (Gross Motor Function Classification System [GMFCS]). Kappa (κ) coefficients were calculated for categorical variables and intraclass correlation coefficients (ICCs) for ordinal data.
Results:
Reliability was excellent in assessing whether or not a child had CP in study 1 (κ=1.00) and substantial in study 2 (κ=0.73); 95% confidence interval [CI] 0.58-0.87). For the neurological subtype, overall κ between paediatricians was 0.85 (95% CI 0.68-0.98), with full agreement observed for eight children. In study 2, overall κ was 0.78 (95% CI 0.61-0.91) with full agreement seen for five children. For the GMFCS, the ICC was 0.88 (95% CI 0.78-0.95) in study 1 and 0.80 (95% CI 0.64-0.91) in study 2.
Interpretation:
Reliability was excellent for all characteristics classified by paediatricians viewing the videos and substantial for professionals reading vignettes.
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