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Inter-rater reliability of paediatric emergency assessment: physiological and clinical features
Calvin Heal1, Sarah Cotterill2, Andrew Graeme Rowland3,4
1Centre for Biostatistics, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK calvin.heal@manchester.ac.uk.
Insights
The Paediatric Admission Guidance in the Emergency Department (PAGE) score shows good inter-rater reliability for most components, indicating its potential for safe clinical decision-making in emergency settings. Nurse judgement showed fair agreement, highlighting an area for refinement.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Assessment Tools
- Healthcare Quality Improvement
Background:
- The Paediatric Admission Guidance in the Emergency Department (PAGE) score is an emerging tool designed to aid hospital admission and discharge decisions in pediatric emergency care.
- Accurate and reliable assessment is crucial for safe patient management in emergency departments and urgent care centers.
- Determining the inter-rater reliability of new scoring systems is essential for validating their clinical utility.
Purpose of the Study:
- To evaluate the inter-rater reliability of seven clinical components of the PAGE score.
- To assess the consistency of scoring when applied by different healthcare professionals.
- To provide evidence for the potential application of the PAGE score in clinical practice.
Main Methods:
- A prospective study was conducted in three sites in North West England (two emergency departments, one urgent care center).
- Two independent raters (assessing nurse and research nurse) consecutively recorded clinical components for 90 pediatric patients (aged 0-16 years).
- Inter-rater reliability was analyzed using kappa statistics (weighted kappa and PABAK) and Bland-Altman plots for continuous data.
Main Results:
- Inter-rater reliability for PAGE score components ranged from moderate to very good (weighted kappa 0.62-0.98).
- The 'nurse judgement' component demonstrated fair agreement (PABAK 0.30).
- Overall scores from 73 children (81%) showed good inter-rater reliability (weighted kappa 0.64).
Conclusions:
- The study findings suggest that nurses can achieve good inter-rater reliability when collecting data for the PAGE score.
- The PAGE score demonstrates applicability for aiding admission and discharge decisions in pediatric emergency settings.
- The methodology presented is suitable for assessing the reliability of clinical scoring systems.
Objective:
The Paediatric Admission Guidance in the Emergency Department (PAGE) score is an assessment tool currently in development that helps predict hospital admission using components including patient characteristics, vital signs (heart rate, temperature, respiratory rate and oxygen saturation) and clinical features (eg, breathing, behaviour and nurse judgement). It aims to assist in safe admission and discharge decision making in environments such as emergency departments and urgent care centres. Determining the inter-rater reliability of scoring tools such as PAGE can be difficult. The aim of this study was to determine the inter-rater reliability of seven clinical components of the PAGE Score.
Design:
Inter-rater reliability was measured by each patient having their clinical components recorded by two separate raters in succession. The first rater was the assessing nurse, and the second rater was a research nurse.
Setting:
Two emergency departments and one urgent care centre in the North West of England. Measurements were recorded over 1 week; data were collected for half a day at each of the three sites.
Patients:
A convenience sample of 90 paediatric attendees (aged 0-16 years), 30 from each of the three sites.
Main Outcome Measures:
Two independent measures for each child were compared using kappa or prevalence-adjusted bias-adjusted kappa (PABAK). Bland-Altman plots were also constructed for continuous measurements.
Results:
Inter-rater reliability ranged from moderate (0.62 (95% CI 0.48 to 0.74) weighted kappa) to very good (0.98 (95% CI 95 to 0.99) weighted kappa) for all measurements except 'nurse judgement' for which agreement was fair (0.30, 95% CI 0.09 to 0.50 PABAK). Complete information from both raters on all the clinical components of the PAGE score were available for 73 children (81%). These total scores showed good' inter-rater reliability (0.64 (95% CI 0.53 to 0.74) weighted kappa).
Conclusions:
Our findings suggest different nurses would demonstrate good inter-rater reliability when collecting acute assessments needed for the PAGE score, reinforcing the applicability of the tool. The importance of determining reliability in scoring systems is highlighted and a suitable methodology was presented.
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