title: Nurse and physician agreement in the assessment of minor blunt head trauma.
abstract: OBJECTIVE
  The Pediatric Emergency Care Applied Research Network (PECARN) traumatic brain injury (TBI) clinical prediction rules identify children with minor blunt head trauma who are at low risk for clinically important traumatic brain injuries. We measured the agreement between the registered nurse (RN) and physician (MD) assessments.
  
  
  METHODS
  We performed a cross-sectional study of all children <18 years of age with minor blunt head trauma who presented to a single emergency department. RNs and MDs independently assessed each child and recorded age-based PECARN predictors. As symptoms can change over time, we included cases only when both evaluations were completed within 60 minutes. We used the κ statistic to measure RN-MD agreement, with the main analysis focusing on the overall PECARN rule agreement.
  
  
  RESULTS
  Of the 1624 eligible children, 1191 (73%) had evaluations completed by both RN and ED providers, of which 437 (37%) were in children <2 years of age. The median time between completions of the provider forms was 12 minutes (interquartile range 4-25 minutes). The overall agreement between the RN and MD was higher for the older children (κ 0.55, 95% confidence interval 0.49-0.61 for children 2-18 years versus κ 0.32, 95% confidence interval 0.23-0.41 for children <2 years).
  
  
  CONCLUSIONS
  The overall agreement between RN and MD for the PECARN TBI prediction rules was moderate for older children and fair for younger children. Initial RN assessments should be verified by the MD before clinical application, especially for the youngest children.
authors: Division of Emergency Medicine, Boston Children’s Hospital, Boston, MA, USA. lise.nigrovic@childrens.harvard.edu
authors: Lise E
authors: LE
authors: Nigrovic
authors: Deborah
authors: D
authors: Schonfeld
authors: Peter S
authors: PS
authors: Dayan
authors: Brianna M
authors: BM
authors: Fitz
authors: Shannon R
authors: SR
authors: Mitchell
authors: Nathan
authors: N
authors: Kuppermann
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D006259:Craniocerebral Trauma / Q000175:diagnosis* / Q000451:nursing*; D003430:Cross-Sectional Studies; D004510:Education, Nursing, Diploma Programs; D004636:Emergency Service, Hospital; D005260:Female; D015600:Glasgow Coma Scale; D016489:Head Injuries, Closed / Q000175:diagnosis* / Q000451:nursing*; D006776:Hospitals, Pediatric; D006801:Humans; D008297:Male; D009722:Nurse Practitioners; D009733:Nursing Diagnosis; D015588:Observer Variation; D019555:Physician-Nurse Relations; D014481:United States
keywords: PECARN; clinical prediction rule; minor blunt head trauma; traumatic brain injury; κ statistic