Related Experiment Video
Updated: Dec 20, 2025
A Pediatric Concussion Model in Mice: Closed Head Injury with Long-Term Disorders (CHILD)
Published on: February 7, 2025
Interobserver Agreement in the Assessment of Clinical Findings in Children with Headaches
Daniel S Tsze1, Andrea T Cruz2, Rakesh D Mistry3
1Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY.
Insights
Interobserver agreement for headache evaluations in children
Area of Science:
- Pediatric Emergency Medicine
- Clinical Assessment
- Neurology
Background:
- Headaches are a common reason for pediatric emergency department (ED) visits.
- Standardized assessment of history and physical examination findings is crucial for accurate diagnosis.
- Interobserver agreement among clinicians evaluating pediatric headaches requires further investigation.
Purpose of the Study:
- To assess the interobserver agreement of history and physical examination findings in children evaluated for headaches in the ED.
- To identify reliable clinical variables for pediatric headache assessment.
Main Methods:
- Prospective, cross-sectional study design.
- Involved 191 children aged 2-17 years with non-traumatic headaches at 3 tertiary pediatric EDs.
- Two independent clinicians completed standardized assessments; unweighted kappa statistics were calculated.
Main Results:
- Moderate to substantial interobserver agreement (κ ≥ 0.41) was found for 60.3% of history variables (41/68).
- Moderate agreement was observed for 61.1% of physical examination variables (11/18).
Conclusions:
- A significant proportion of history and physical examination findings show moderate interobserver agreement in pediatric headache evaluations.
- Reliable clinical variables could inform the development of clinical prediction rules for children with headaches.
- These findings may enhance consistency in evaluating pediatric headaches across different clinicians and settings.
Objective:
To determine the interobserver agreement of history and physical examination findings in children undergoing evaluation in the emergency department (ED) for headaches.
Study Design:
We conducted a prospective, cross-sectional study of children aged 2-17 years evaluated at 3 tertiary-care pediatric EDs for non-traumatic headaches. Two clinicians independently completed a standardized assessment of each child and documented the presence or absence of history and physical examination variables. Unweighted κ statistics were determined for 68 history and 24 physical examination variables.
Results:
We analyzed 191 paired observations; median age was 12 years, with 19 (9.9%) children younger than 7 years. Interrater reliability was at least moderate (κ ≥ 0.41) for 41 (60.3%) patient history variables. Eleven (61.1%) of 18 physical examination variables for which κ statistics could be calculated had a κ that was at least moderate.
Conclusions:
A substantial number of history and physical examination findings demonstrated at least moderate κ statistic values when assessed in children with headaches in the ED. These variables may be generalizable across different types of clinicians for evaluation of children with headaches. If also found to predict the presence or absence of emergent intracranial abnormalities, the more reliable clinical findings may be helpful in the development of clinical prediction rules or risk stratification models that could be used across settings for children with headaches.
