Inter-rater reliability in the Paediatric Observation Priority Score (POPS)

Langton, L; Bonfield, Adam; Roland, Damian

doi:10.1136/archdischild-2017-314165

Cited by 5 publications

(2 citation statements)

References 19 publications

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“…Since the VWS includes main objective vital parameters together with the criterion ‘work of breathing’, we reasoned this would be a more valid score to use. We used an adapted bedside PEWS, since this score was already in use at two of five participating sites and has acceptable inter-rater reliability and usability 18 26 27…”

Section: Discussionmentioning

confidence: 99%

High-flow oxygen therapy in moderate to severe bronchiolitis: a randomised controlled trial

et al. 2023

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Background and objectiveHigh-flow (HF) oxygen therapy is being used increasingly in infants with bronchiolitis, despite lack of convincing evidence of its superiority over low flow (LF). We aimed to compare the effect of HF to LF in moderate to severe bronchiolitis.MethodsMulticentre randomised controlled trial during four winter seasons (2016–2020) including 107 children under 2 years of age admitted with moderate to severe bronchiolitis, oxygen saturation of <92% and severely impaired vital signs. Crossovers were not allowed. HF was administered at flow rates of 2 L/kg for the first 10 kg, plus 0.5 L/kg for every kg >10 kg, LF with a maximum flow rate of 3 L/min. Primary outcome was improvement of vital signs and dyspnoea severity within 24 hours assessed by a composite score. Secondary outcomes were comfort, duration of oxygen therapy, supplemental feedings, hospitalisation duration and intensive care admission for invasive ventilation.ResultsSignificant improvement within 24 hours occurred in 73% of 55 patients randomised to HF and in 78% of 52 patients with LF (difference 6%, 95% CI −13% to 23%). Intention-to-treat analysis revealed no significant differences in any secondary outcome: duration of oxygen therapy, supplemental feedings, hospitalisation and need for invasive ventilation or intensive care admission, except for comfort (face, legs, activity, cry, consolability), which was one point (out of a scale of 0–10) higher in the LF group. No adverse effects occurred.ConclusionWe found no measurable clinically relevant benefit in the use of HF compared with LF in hypoxic children with moderate to severe bronchiolitis.Trial registration numberNCT02913040.

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Section: Discussionmentioning

confidence: 99%

High-flow oxygen therapy in moderate to severe bronchiolitis: a randomised controlled trial

et al. 2023

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“…4 When examined using previously recorded video assessments of children, POPS has been shown to have 'perfect' inter-rater reliability for well children and 'good' inter-rater reliability with an intraclass correlation coefficient (ICC) between 0.66 and 0.74 for unwell children. 5 A subsequent study with a larger sample of children (n=11 videos) and raters (n=46) found a high overall ICC between the raters (95% CI 0.71 to 0.95). 6 On individual components of POPS, the study found high rates of agreement (Fleiss' kappa) for oxygen saturation (over 0.87) and pulse (over 0.76).…”

Section: Original Researchmentioning

confidence: 91%

Inter-rater reliability of paediatric emergency assessment: physiological and clinical features

et al. 2020

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ObjectiveThe 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.DesignInter-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.SettingTwo 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.PatientsA convenience sample of 90 paediatric attendees (aged 0–16 years), 30 from each of the three sites.Main outcome measuresTwo 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.ResultsInter-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).ConclusionsOur 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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Analysis of emergency department prediction tools in evaluating febrile young infants at risk for serious infections

Yao¹,

Ong

Maconochie

et al. 2019

Emerg Med J

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ObjectiveFebrile infants≤3 months old constitute a vulnerable group at risk of serious infections (SI). We aimed to (1) study the test performance of two clinical assessment tools—the National Institute for Health and Care Excellence (NICE) Traffic Light System and Severity Index Score (SIS) in predicting SI among all febrile young infants and (2) evaluate the performance of three low-risk criteria—the Rochester Criteria (RC), Philadelphia Criteria (PC) and Boston Criteria (BC) among well-looking febrile infants.MethodsA retrospective validation study was conducted. Serious illness included both bacterial and serious viral illness such as meningitis and encephalitis. We included febrile infants≤3 months old presenting to a paediatric emergency department in Singapore between March 2015 and February 2016. Infants were assigned to high-risk and low-risk groups for SI according to each of the five tools. We compared the performance of the NICE guideline and SIS at initial clinical assessment for all infants and the low-risk criteria—RC, PC and BC—among well-looking infants. We presented their performance using sensitivity, specificity, positive, negative predictive values and likelihood ratios.ResultsOf 1057 infants analysed, 326 (30.8%) were diagnosed with SI. The NICE guideline had an overall sensitivity of 93.3% (95% CI 90.0 to 95.7), while the SIS had a sensitivity of 79.1% (95% CI 74.3 to 83.4). The incidence of SI was similar among infants who were well-looking and those who were not. Among the low-risk criteria, the RC performed with the highest sensitivity in infants aged 0–28 days (98.2%, 95% CI 90.3% to 100.0%) and 29–60 days (92.4%, 95% CI 86.0% to 96.5%), while the PC performed best in infants aged 61–90 days (100.0%, 95% CI 95.4% to 100.0%).ConclusionsThe NICE guideline achieved high sensitivity in our study population, and the RC had the highest sensitivity in predicting for SI among well-appearing febrile infants. Prospective validation is required.

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Inter-rater reliability in the Paediatric Observation Priority Score (POPS)

Cited by 5 publications

References 19 publications

High-flow oxygen therapy in moderate to severe bronchiolitis: a randomised controlled trial

High-flow oxygen therapy in moderate to severe bronchiolitis: a randomised controlled trial

Inter-rater reliability of paediatric emergency assessment: physiological and clinical features

Analysis of emergency department prediction tools in evaluating febrile young infants at risk for serious infections

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