Reliability of clinical examinations for pediatric skin and soft-tissue infections.
OBJECTIVE
To determine the interrater reliability of clinical examination by pediatric emergency medicine physicians for the diagnosis of skin and soft-tissue infections (SSTIs).


METHODS
A cross-sectional study of patients presenting to a pediatric emergency department with SSTIs was performed. Each lesion was examined by a treating physician and a study physician (from a pool of 62 physicians) at the bedside during the emergency department visit. The primary outcome was reliability, as measured with the weighted κ statistic, for determining whether the lesion was an abscess and whether the lesion required a drainage procedure.


RESULTS
A total of 371 lesions were analyzed for interrater reliability. The weighted κ value for diagnosis of the lesion as an abscess was 0.39 (95% confidence interval: 0.32-0.47), and that for assessment of the need for drainage was 0.43 (95% confidence interval: 0.36-0.51). Agreement was statistically more likely for lesions in children ≥ 4 years of age but was not more likely for lesions in nonblack patients, lesions in patients with a history of or exposure to a close contact with a SSTI, or lesions examined by 2 experienced pediatric emergency medicine physicians.


CONCLUSIONS
Among the 62 participating physicians at our site, the reliability of the clinical examination was poor. This may indicate that improved education and/or more-objective means for diagnosing these infections in the acute care setting are warranted. Additional studies are needed to determine whether these results are generalizable to other settings.
Children's Hospital of Pittsburgh, Division of Emergency Medicine, 4401 Penn Ave, AOB, Suite 2400, Pittsburgh, PA 15224, USA. marinj@email.chop.edu
Jennifer R
JR
Marin
Warren
W
Bilker
Ebbing
E
Lautenbach
Elizabeth R
ER
Alpern
D000038:Abscess / Q000175:diagnosis* / Q000453:epidemiology / Q000601:surgery; D000293:Adolescent; D000367:Age Factors; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D004322:Drainage; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007223:Infant; D016013:Likelihood Functions; D008297:Male; D015588:Observer Variation; D010808:Physical Examination / Q000706:statistics & numerical data*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012874:Skin Diseases, Infectious / Q000175:diagnosis* / Q000453:epidemiology; D018461:Soft Tissue Infections / Q000175:diagnosis* / Q000453:epidemiology; D055815:Young Adult