title: The inter-observer agreement of examining pre-school children with acute cough: a nested study.
abstract: BACKGROUND
  The presence of clinical signs have implications for diagnosis, prognosis and treatment. Therefore, the aim of this study was to examine the inter-observer agreement of clinical signs in pre-school children presenting to primary care.
  
  
  METHODS
  A nested study comparing two clinical assessments within a prospective cohort of 256 pre-school children with acute cough recruited from eight general practices in Leicestershire, UK. We examined agreement (using kappa statistics) between unstandardised and standardised clinical assessments of tachypnoea, chest signs and fever.
  
  
  RESULTS
  Kappa values were poor or fair for all clinical signs (range 0.12 to 0.39) with chest signs the most reliable.
  
  
  CONCLUSIONS
  Primary care clinicians should be aware that clinical signs may be unreliable when making diagnosis, prognosis and treatment decisions in pre-school children with cough. Future research should aim to further our understanding of how best to identify abnormal clinical signs.
authors.affiliation: Division of Primary Health Care, University of Bristol, Cotham House, Cotham Hill, Bristol, BS6, 6JL, UK. alastair.hay@bristol.ac.uk
authors.forename: Alastair D
authors.initials: AD
authors.lastname: Hay
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilson
authors.forename: Tom
authors.initials: T
authors.lastname: Fahey
authors.forename: Tim J
authors.initials: TJ
authors.lastname: Peters
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001314:Auscultation; D001831:Body Temperature; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003371:Cough / Q000175:diagnosis* / Q000188:drug therapy; D005334:Fever / Q000175:diagnosis; D006302:Health Services Research; D006801:Humans; D006985:Hyperventilation / Q000175:diagnosis; D007223:Infant; D015588:Observer Variation; D010808:Physical Examination; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D011379:Prognosis; D011446:Prospective Studies; D012135:Respiratory Sounds; D012494:Sampling Studies; D012621:Seasons
chemical_list: D000900:Anti-Bacterial Agents