title: Interobserver agreement in retrospective chart reviews for factors associated with cervical spine injuries in children.
abstract: OBJECTIVE
  The objective was to describe the interobserver agreement between trained chart reviewers and physician reviewers in a multicenter retrospective chart review study of children with cervical spine injuries (CSIs).
  
  
  METHODS
  Medical records of children younger than 16 years old with cervical spine radiography from 17 Pediatric Emergency Care Applied Research Network (PECARN) hospitals from years 2000 through 2004 were abstracted by trained reviewers for a study aimed to identify predictors of CSIs in children. Independent physician-reviewers abstracted patient history and clinical findings from a random sample of study patient medical records at each hospital. Interobserver agreement was assessed using percent agreement and the weighted kappa (κ) statistic, with lower 95% confidence intervals.
  
  
  RESULTS
  Moderate or better agreement (κ > 0.4) was achieved for most candidate CSI predictors, including altered mental status (κ = 0.87); focal neurologic findings (κ = 0.74); posterior midline neck tenderness (κ = 0.74); any neck tenderness (κ = 0.89); torticollis (κ = 0.79); complaint of neck pain (κ = 0.83); history of loss of consciousness (κ = 0.89); nonambulatory status (κ = 0.74); and substantial injuries to the head (κ = 0.50), torso/trunk (κ = 0.48), and extremities (κ = 0.59). High-risk mechanisms showed near-perfect agreement (diving, κ = 1.0; struck by car, κ = 0.93; other motorized vehicle crash, κ = 0.93; fall, κ = 0.92; high-risk motor vehicle collision, κ = 0.89; hanging, κ = 0.80). Fair agreement was found for clotheslining mechanisms (κ = 0.36) and substantial face injuries (κ = 0.40).
  
  
  CONCLUSIONS
  Most retrospectively assessed variables thought to be predictive of CSIs in blunt trauma-injured children had at least moderate interobserver agreement, suggesting that these data are sufficiently valid for use in identifying potential predictors of CSI.
authors.affiliation: The Division of Critical Care, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT.
authors.forename: Cody S
authors.initials: CS
authors.lastname: Olsen
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
authors.forename: David M
authors.initials: DM
authors.lastname: Jaffe
authors.forename: Kathleen
authors.initials: K
authors.lastname: Brown
authors.forename: Lynn
authors.initials: L
authors.lastname: Babcock
authors.forename: Prashant V
authors.initials: PV
authors.lastname: Mahajan
authors.forename: Julie C
authors.initials: JC
authors.lastname: Leonard
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008499:Medical Records / Q000706:statistics & numerical data*; D019838:Neck Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D015588:Observer Variation; D010372:Pediatrics; D011859:Radiography; D012189:Retrospective Studies; D013124:Spinal Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D014949:Wounds, Nonpenetrating / Q000150:complications