Interrater Reliability of Cervical Spine Injury Criteria in Patients With Blunt Trauma

Mahadevan, Swaminatha V.; Mower, William R.; Hoffman, Jerome R.; Peeples, Neal; Goldberg, William; Sonner, Richard

doi:10.1016/s0196-0644(98)70306-3

Cited by 49 publications

(30 citation statements)

References 15 publications

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“…The NEXUS study prospectively enrolled children and adults at risk of CSI and showed altered neurologic function j = 0.58, midline neck tenderness j = 0.77, and distracting injury j = 0.77. 7 A prospective study of traumatic brain injuries found high agreement for injury mechanism and history of loss of consciousness and moderate agreement for altered mental status. 8 A prospective study of blunt abdominal trauma found almost perfect agreement for injury mechanism and moderate agreement for painful injury, difficulty breathing, and tenderness.…”

Section: Discussionmentioning

confidence: 99%

Interobserver Agreement in Retrospective Chart Reviews for Factors Associated With Cervical Spine Injuries in Children

Olsen

Kuppermann

Jaffe

et al. 2015

Academic Emergency Medicine

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Objectives: The objective was to describe the interobserver agreement between trained chart reviewers and physician reviewers in a multicenter retrospective chart review study of children with cervical spine injuries (CSIs).Methods: Medical records of children younger than 16 years old with cervical spine radiography from 17 Pediatric Emergency Care Applied Research Network (PECARN) hospitals from years 2000 through 2004 were abstracted by trained reviewers for a study aimed to identify predictors of CSIs in children. Independent physician-reviewers abstracted patient history and clinical findings from a random sample of study patient medical records at each hospital. Interobserver agreement was assessed using percent agreement and the weighted kappa (j) statistic, with lower 95% confidence intervals.Results: Moderate or better agreement (j > 0.4) was achieved for most candidate CSI predictors, including altered mental status (j = 0.87); focal neurologic findings (j = 0.74); posterior midline neck tenderness (j = 0.74); any neck tenderness (j = 0.89); torticollis (j = 0.79); complaint of neck pain (j = 0.83); history of loss of consciousness (j = 0.89); nonambulatory status (j = 0.74); and substantial injuries to the head (j = 0.50), torso/trunk (j = 0.48), and extremities (j = 0.59). High-risk mechanisms showed near-perfect agreement (diving, j = 1.0; struck by car, j = 0.93; other motorized vehicle crash, j = 0.93; fall, j = 0.92; high-risk motor vehicle collision, j = 0.89; hanging, j = 0.80). Fair agreement was found for clotheslining mechanisms (j = 0.36) and substantial face injuries (j = 0.40).Conclusions: Most retrospectively assessed variables thought to be predictive of CSIs in blunt traumainjured children had at least moderate interobserver agreement, suggesting that these data are sufficiently valid for use in identifying potential predictors of CSI.ACADEMIC EMERGENCY MEDICINE 2015;22:487-491

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Section: Discussionmentioning

confidence: 99%

Interobserver Agreement in Retrospective Chart Reviews for Factors Associated With Cervical Spine Injuries in Children

Olsen

Kuppermann

Jaffe

et al. 2015

Academic Emergency Medicine

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“…This question could be addressed in a future study. Mahadevan et al's results, 24 however, suggested that the delay between examinations did not adversely affect interrater reliability in their study.…”

Section: Limitations and Future Questionsmentioning

confidence: 61%

“…Mahadevan et al 24 stated that such criteria would be of limited usefulness if health care providers could not apply them consistently to the same patients. Their study demonstrated high interrater reliability among emergency physicians (EPs) for the application of risk criteria similar to those used in previous studies [14][15][16]19,21,23 for clinically clearing cervical spinal injuries.…”

mentioning

confidence: 99%

Clinical Clearance of Cervical Spinal Injuries by Emergency Nurses

Hsieh

Gutman

Haliscak

2000

Academic Emergency Medicine

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Abstract. Objectives: To determine the interrater reliability between emergency nurses and emergency physicians on defined criteria for clinically clearing the cervical spine in blunt trauma patients. Methods: Blunt trauma patients, 12 years or older, arriving with cervical spinal precautions were prospectively enrolled as a convenience sample. Each member of the emergency physician-nurse pair completed a questionnaire with regard to five criteria for clinically clearing the cervical spine for each patient. Interrater reliability was determined by calculating the statistics for the individual and combined criteria. Results: Physicians and nurses agreed on the presence or absence of the combined criteria in 175 of 211 patients (82.9%; , 0.65). Agreements on individual criteria were as follows: 1) intoxication-203 patients (96.2%; , 0.82); 2) altered consciousness-197 patients (93.4%; , 0.60); 3) neck pain-185 patients (87.7%; , 0.75); 4) distracting injury-160 patients (75.8%; , 0.36); and 5) neurologic deficit-198 patients (93.8%; , 0.45). If disagreements in which the physician would clinically clear the patient but the nurse would not were considered as agreements, then overall agreement would be 198 of 211 patients (93.8%; , 0.88). On the assumption that nurses would assess patients prior to physicians, they would have cleared 35% of the patients before the physicians. However, they would have ordered 12% more radiographs and unsafely clinically cleared 5% of the patients. Conclusions: The interrater reliability for the combined cervical spinal injury criteria between emergency nurses and physicians was good to excellent. However, with the training given in this study, nurses would order more radiographs than physicians and would unsafely clinically clear cervical spines in some patients.

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“…Only 1 study measured interobserver agreement to assess reliability. 53 Eligibility criteria have often been unclear in previous studies, making it difficult for readers to interpret and apply the findings to their own patients. Most studies lacked a standardized patient definition, enrolling any trauma patient who had C-spine films ordered at the treating physician's discretion.…”

Section: Previous Guidelines For Cervical Spine Radiographymentioning

confidence: 99%

Canadian C-Spine Rule study for alert and stable trauma patients: I. Background and rationale

Stiell

Wells

McKnight

et al. 2002

CJEM

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This paper is Part I of a 2-part series to describe the background and methodology for the Canadian C-Spine Rule study to develop a clinical decision rule for rational imaging in alert and stable trauma patients. Current use of radiography is inefficient and variable, in part because there has been a lack of evidence-based guidelines to assist emergency physicians. Clinical decision rules are research-based decision-making tools that incorporate 3 or more variables from the history, physical examination or simple tests. The Canadian CT Head and C-Spine (CCC) Study is a large collaborative effort to develop clinical decision rules for the use of CT head in minor head injury and for the use of cervical spine radiography in alert and stable trauma victims. Part I details the background and rationale for the development of the Canadian C-Spine Rule. Part II will describe in detail the objectives and methods of the Canadian C-Spine Rule study. RÉSUMÉIl s'agit de la première partie d'un article en deux parties décrivant le contexte et la méthodologie de l'étude de la Règle canadienne concernant la colonne cervicale (Canadian C-Spine Rule study) visant à établir une règle de décision pour le recours rationnel à l'imagerie chez les victimes de traumatismes alertes et stables. Le recours actuel à la radiographie est inefficace et variable, en partie en raison d'un manque de lignes directrices fondées sur des données probantes pour guider les urgentologues. Les règles de décision clinique sont des outils de prise de décision fondés sur des recherches qui incorporent trois variables ou plus provenant des antécédents, de l'examen physique ou de simples tests. L'étude canadienne concernant les tomodensitogrammes de la tête et la colonne cervicale (Canadian CT Head and C-Spine Study) est un effort de collaboration sur une grande échelle visant à mettre sur pied des règles de décision clinique quant au recours au tomodensitogramme de la tête dans les cas de blessures mineures à la tête et à la radiographie de la colonne cervicale chez les victimes de traumatismes alertes et stables. La première partie décrit le contexte de la mise sur pied de la Règle canadienne concernant la colonne cervicale et sa justification. La deuxième partie décrira en détail les objectifs et méthodes de l'étude de cette Règle.

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Interrater Reliability of Cervical Spine Injury Criteria in Patients With Blunt Trauma

Cited by 49 publications

References 15 publications

Interobserver Agreement in Retrospective Chart Reviews for Factors Associated With Cervical Spine Injuries in Children

Interobserver Agreement in Retrospective Chart Reviews for Factors Associated With Cervical Spine Injuries in Children

Clinical Clearance of Cervical Spinal Injuries by Emergency Nurses

Canadian C-Spine Rule study for alert and stable trauma patients: I. Background and rationale

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