title: Reliability Testing of the Balance Error Scoring System in Children Between the Ages of 5 and 14.
abstract: OBJECTIVE
  Pediatric concussion is an extensive public health concern with a complex clinical presentation. Balance assessment has been well-studied in the adult population, but has been limited in children. We aimed to assess the reliability and minimum detectable change (MDC) of the Balance Error Scoring System (BESS) in healthy children.
  
  
  METHODS
  This prospective observational study included 373 healthy children aged 5 to 14. Interrater reliability was assessed by having 4 assessors review videos of 50 random subjects distributed evenly by age and sex across the entire cohort. Intrarater reliability was performed by having assessors review videos of other assessors' live evaluations. Test-retest reliability was obtained by comparing BESS scores as recorded live at the 2 separate time points by the same rater.
  
  
  METHODS
  Local elementary and junior high schools.
  
  
  METHODS
  Three hundred and seventy three healthy children between the ages of 5 and 14.
  
  
  METHODS
  The BESS was performed on all children.
  
  
  METHODS
  Intraclass Correlation Coefficients (ICCs) and MDC Scores.
  
  
  RESULTS
  The overall interrater ICC was determined to be 0.93 [95% confidence interval (CI), 0.79-0.97] and intrarater ICC was 0.96 (95% CI, 0.95-0.97) with individual intrarater ICCs ranging between 0.69 and 0.99. The test-retest reliability was 0.90 (95% CI, 0.88-0.92). The MDCs were 9.6, 4.6, and 7.3 points at the 95% CIs for interrater, intrarater, and test-retest comparisons, respectively. No learning effect was seen.
  
  
  CONCLUSIONS
  The BESS demonstrates excellent reliability in the pediatric population without evidence of a learning effect.
authors.affiliation: *Division of Physical Medicine and Rehabilitation, University of Utah, Salt Lake City, Utah; †Division of Epidemiology, University of Utah, Salt Lake City, Utah; and ‡Department of Orthopedics, University of Utah, Salt Lake City, Utah.
authors.forename: Colby
authors.initials: C
authors.lastname: Hansen
authors.forename: Dan
authors.initials: D
authors.lastname: Cushman
authors.forename: Wei
authors.initials: W
authors.lastname: Chen
authors.forename: Jerry
authors.initials: J
authors.lastname: Bounsanga
authors.forename: Man
authors.initials: M
authors.lastname: Hung
mesh_terms: D000293:Adolescent; D001924:Brain Concussion / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D004856:Postural Balance; D011446:Prospective Studies; D015203:Reproducibility of Results; D012720:Severity of Illness Index
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