Reliable Assessors of Infant Cranial Asymmetry in Child Health Care
Freda Lennartsson1, Göran Wennergren2, Per Nordin3
1Department of Pediatrics, University of Gothenburg, 416 85 Gothenburg, Sweden.
Insights
Trained assessors demonstrated reliable and interchangeable judgment of infant cranial asymmetry. This finding supports the use of trained healthcare professionals for early detection of positional plagiocephaly.
Area of Science:
- Pediatric Health
- Biostatistics
- Clinical Assessment
Background:
- Infant cranial asymmetry is common, often linked to recommended supine sleep positions.
- Early detection and prevention are crucial to mitigate risks of permanent asymmetry.
- A Swedish project aimed to develop and implement an intervention for infant cranial asymmetry.
Purpose of the Study:
- To evaluate the reliability of assessors in judging infant cranial asymmetry.
- To determine if assessors could be considered interchangeable for a planned intervention.
Main Methods:
- Five assessors were trained using illustrated severity assessments for infant cranial asymmetry.
- Intra-rater and inter-rater reliability were tested using photograph test-retest and infant assessments.
- Agreement was analyzed using AC2 statistics, adjusted for genuine agreement, and interpreted using Landis and Koch intervals.
Main Results:
- Photograph test: Mean intra-rater agreement was 73%; adjusted intra-rater AC2 was 0.69; adjusted inter-rater AC2s ranged from 0.71 to 0.72.
- Infant test: Adjusted inter-rater AC2 was 0.73.
- Results indicated substantial agreement among assessors.
Conclusions:
- Assessors demonstrated reliable and interchangeable performance in judging infant cranial asymmetry.
- Educating child healthcare nurses can facilitate early detection of infant cranial asymmetry in clinical settings.
Introduction:
Acquired cranial asymmetry is prevalent in infants today and largely attributed to the supine sleep position recommended for infant safety. There is a risk of permanent cranial asymmetry, so prevention and early detection are important. A prevention project was initiated in Sweden, and an intervention was planned. The aim of this study was to evaluate reliability of assessors judging infant cranial asymmetry in order to evaluate if they could be considered reliable interchangeable assessors in the planned intervention.
Materials And Methodology:
Five assessors were taught how to assess infant cranial asymmetry using illustrated severity assessments. They were intra-rater and inter-rater reliability tested by taking a photograph test-retest and an infant test. Agreement matrices were devised to illustrate assessor agreement based on both type and degree of cranial asymmetry. Agreement based on degree of asymmetry was analyzed by calculating AC2 using quadratic weights. Results were adjusted to arrive at the perceived genuine agreement and interpreted according to Landis and Koch's strength of agreement intervals.
Results:
In the photograph test, mean percentage of perfect intra-rater agreement was 73. Adjusted mean intra-rater AC2 was 0.69 [0.63; 0.76], and adjusted inter-rater AC2s were 0.72 [0.64; 0.81] and 0.71 [0.63; 0.79]. In the infant test, the adjusted inter-rater AC2 was 0.73 [0.60; 0.87]. Results indicate substantial strength of assessor agreement.
Conclusion:
Assessors were reliable and interchangeable. In a larger clinical context, results indicate that educating child health care nurses to assess infant cranial asymmetry can be used for early detection.
