title: Interrater reliability of clinical findings in children with possible appendicitis.
abstract: OBJECTIVE
  Our objective was to determine the interrater reliability of clinical history and physical examination findings in children undergoing evaluation for possible appendicitis in a large, multicenter cohort.
  
  
  METHODS
  We conducted a prospective, multicenter, cross-sectional study of children aged 3-18 years with possible appendicitis. Two clinicians independently evaluated patients and completed structured case report forms within 60 minutes of each other and without knowing the results of diagnostic imaging. We calculated raw agreement and assessed reliability by using the unweighted Cohen κ statistic with 2-sided 95% confidence intervals.
  
  
  RESULTS
  A total of 811 patients had 2 assessments completed, and 599 (74%) had 2 assessments completed within 60 minutes. Seventy-five percent of paired assessments were completed by pediatric emergency physicians. Raw agreement ranged from 64.9% to 92.3% for history variables and 4 of 6 variables had moderate interrater reliability (κ > .4). The highest κ values were noted for duration of pain (κ = .56 [95% confidence intervals .51-.61]) and history of emesis (.84 [.80-.89]). For physical examination variables, raw agreement ranged from 60.9% to 98.7%, with 4 of 8 variables exhibiting moderate reliability. Among physical examination variables, the highest κ values were noted for abdominal pain with walking, jumping, or coughing (.54 [.45-.63]) and presence of any abdominal tenderness on examination (.49 [.19-.80]).
  
  
  CONCLUSIONS
  Interrater reliability of patient history and physical examination variables was generally fair to moderate. Those variables with higher interrater reliability are more appropriate for inclusion in clinical prediction rules in children with possible appendicitis.
authors.affiliation: Department of Pediatrics, Columbia University College of Physicians and Surgeons, New York, New York, USA. ak493@columbia.edu
authors.forename: Anupam B
authors.initials: AB
authors.lastname: Kharbanda
authors.forename: Michelle D
authors.initials: MD
authors.lastname: Stevenson
authors.forename: Charles G
authors.initials: CG
authors.lastname: Macias
authors.forename: Kelly
authors.initials: K
authors.lastname: Sinclair
authors.forename: Nanette C
authors.initials: NC
authors.lastname: Dudley
authors.forename: Jonathan
authors.initials: J
authors.lastname: Bennett
authors.forename: Lalit
authors.initials: L
authors.lastname: Bajaj
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Mittal
authors.forename: Craig
authors.initials: C
authors.lastname: Huang
authors.forename: Richard G
authors.initials: RG
authors.lastname: Bachur
authors.forename: Peter S
authors.initials: PS
authors.lastname: Dayan
mesh_terms: D015746:Abdominal Pain / Q000175:diagnosis* / Q000209:etiology; D000208:Acute Disease; D000293:Adolescent; D001064:Appendicitis / Q000150:complications / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003937:Diagnosis, Differential; D003952:Diagnostic Imaging; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D010808:Physical Examination; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D014481:United States / Q000453:epidemiology