title: Interobserver agreement in the assessment of clinical findings in children with first unprovoked seizures.
abstract: OBJECTIVE
  Variables used in prediction rules and clinical guidelines should show acceptable agreement when assessed by different observers. Our objective was to determine the interobserver agreement of patient history and physical examination variables used to assess children undergoing emergency department (ED) evaluation for a first seizure not provoked by a known precipitant such as fever or trauma (ie, an unprovoked seizure).
  
  
  METHODS
  We conducted a prospective cohort study of children aged 28 days to 18 years evaluated for unprovoked seizures at 6 tertiary care EDs. We excluded patients if previously evaluated for a similar event. Two clinicians independently completed a clinical assessment before neuroimaging. We determined agreement for each clinical variable by using the unweighted κ statistic.
  
  
  RESULTS
  A total of 217 paired observations were analyzed; median patient age was 53.5 months, and 38% were younger than 2 years. Agreement beyond chance was at least moderate (κ ≥ 0.41) for 21 of 31 (68%) variables for which κ could be calculated. κ was ≥0.41 for 7 of 11 (64%) general history variables, all 8 seizure-specific history variables (including seizure focality), and 6 of 12 (50%) physical examination variables. Agreement beyond chance was substantial or better (κ ≥ 0.61) for 2 of 11 (18%) general history variables, for 5 of 8 (63%) seizure-specific history variables, and for 2 of 12 (17%) physical examination variables.
  
  
  CONCLUSIONS
  For children with first unprovoked seizures evaluated in the ED, clinicians frequently assess findings from seizure-specific history with substantial agreement beyond chance. Those clinical variables that have been associated with the presence of intracranial abnormalities and show reliability between assessors, such as seizure focality and the presence of any focal neurological finding, may be more useful in the ED assessment of children with first unprovoked seizures.
authors.affiliation: Columbia University College of Physicians and Surgeons, Morgan Stanley Children's Hospital of New York, 622 W 168th St, PH 137, New York, NY 10032, USA. psd6@columbia.edu
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
authors.forename: Kathleen
authors.initials: K
authors.lastname: Lillis
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bennett
authors.forename: Gregory
authors.initials: G
authors.lastname: Conners
authors.forename: Pam
authors.initials: P
authors.lastname: Bailey
authors.forename: James
authors.initials: J
authors.lastname: Callahan
authors.forename: Cidgem
authors.initials: C
authors.lastname: Akman
authors.forename: Neil
authors.initials: N
authors.lastname: Feldstein
authors.forename: W Allen
authors.initials: WA
authors.lastname: Hauser
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D000046:Academic Medical Centers; D000293:Adolescent; D017668:Age of Onset; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003952:Diagnostic Imaging / Q000592:standards* / Q000639:trends; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009483:Neuropsychological Tests / Q000592:standards; D015588:Observer Variation; D010808:Physical Examination / Q000592:standards* / Q000639:trends; D011446:Prospective Studies; D012640:Seizures / Q000175:diagnosis* / Q000453:epidemiology; D012720:Severity of Illness Index