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.
Marin
Jennifer R
JR
Children's Hospital of Pittsburgh, Division of Emergency Medicine, 4401 Penn Ave, AOB, Suite 2400, Pittsburgh, PA 15224, USA. marinj@email.chop.edu
Bilker
Warren
W
Lautenbach
Ebbing
E
Alpern
Elizabeth R
ER
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