title: The interrater reliability of a validated bronchiolitis severity assessment tool.
abstract: BACKGROUND
  We previously constructed and tested a bronchiolitis severity assessment tool in 2 independent hospitals. The model uses age, work of breathing, dehydration and tachycardia to successfully predict disease severity.
  
  
  OBJECTIVE
  To prospectively measure the interrater reliability of a bronchiolitis severity assessment tool and of its component variables.
  
  
  METHODS
  Prospective observational survey.
  
  
  METHODS
  A county teaching hospital emergency department serving a mixed urban and rural population with an emergency medicine residency program in 2-3-4 format.
  
  
  METHODS
  Thirty-two physicians evaluated a convenience sample of children aged less than 18 months presenting to the emergency department with a clinical diagnosis of bronchiolitis during a single season.
  
  
  METHODS
  Two physicians independently examined each patient. Each physician completed a physical examination template that included the variables used in the severity assessment tool. Interrater agreement was measured for the variables work of breathing and dehydration and for the tool as a whole using a weighted kappa statistic.
  
  
  RESULTS
  One hundred and forty-six cases were enrolled. Twenty-five were dropped for incomplete data collection. The actual weighted agreement on overall classification was 92%; expected, 73%, kappa = 0.676; P < 0.0001. The actual weighted agreement for dehydration was at 95%; expected, 92%, kappa = 0.305; P = 0.0001. The agreement for work of breathing was 95%; expected, 86%; kappa = 0.611; P < 0.0001. The overall model showed better interrater reliability than its individual components.
  
  
  CONCLUSIONS
  Overall interrater reliability for this bronchiolitis severity assessment tool is substantial.
authors.affiliation: Department of Emergency Medicine, Kern Medical Center, Bakersfield, CA 93305, USA. yousentwhohome@yahoo.com
authors.forename: Paul
authors.initials: P
authors.lastname: Walsh
authors.forename: Adrian
authors.initials: A
authors.lastname: Gonzales
authors.forename: Amina
authors.initials: A
authors.lastname: Satar
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Rothenberg
mesh_terms: D001988:Bronchiolitis / Q000145:classification* / Q000175:diagnosis; D004522:Educational Status; D004635:Emergency Medicine / Q000193:education / Q000706:statistics & numerical data; D005180:Faculty, Medical / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007396:Internship and Residency / Q000706:statistics & numerical data; D015588:Observer Variation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index