title: Interobserver Reliability of the Respiratory Physical Examination in Premature Infants: A Multicenter Study.
abstract: OBJECTIVE
  To measure the inter-rater reliability of 7 visual and 3 auscultatory respiratory physical examination findings at 36-40 weeks' postmenstrual age in infants born less than 29 weeks' gestation. Physicians also estimated the probability that each infant would remain hospitalized for 3 months after the examination or be readmitted for a respiratory illness during that time.
  
  
  METHODS
  Prospective, multicenter, inter-rater reliability study using standardized audio-video recordings of respiratory physical examinations.
  
  
  RESULTS
  We recorded the respiratory physical examination of 30 infants at 2 centers and invited 32 physicians from 9 centers to review the examinations. The intraclass correlation values for physician agreement ranged from 0.73 (95% CI 0.57-0.85) for subcostal retractions to 0.22 (95% CI 0.11-0.41) for expiratory abdominal muscle use. Eight (27%) infants remained hospitalized or were readmitted within 3 months after the examination. The area under the receiver operating characteristic curve for prediction of this outcome was 0.82 (95% CI 0.78-0.86). Physician predictive accuracy was greater for infants receiving supplemental oxygen (0.90, 95% CI 0.86-0.95) compared with those breathing in room air (0.71, 95% CI 0.66-0.75).
  
  
  CONCLUSIONS
  Physicians often do not agree on respiratory physical examination findings in premature infants. Physician prediction of short-term respiratory morbidity was more accurate for infants receiving supplemental oxygen compared with those breathing in room air.
authors: Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA. Electronic address: jensene@email.chop.edu.
authors: Erik A
authors: EA
authors: Jensen
authors: Department of Pediatrics, Division of Pulmonology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors: Howard
authors: H
authors: Panitch
authors: Department of Biostatistics and Epidemiology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors: Rui
authors: R
authors: Feng
authors: Department of Pediatrics, Division of Pediatric Allergy, Immunology, and Pulmonary Medicine, Vanderbilt University School of Medicine, Nashville, TN.
authors: Paul E
authors: PE
authors: Moore
authors: Department of Pediatrics, Division of Neonatology, The Children's Hospital of Philadelphia and The University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
authors: Barbara
authors: B
authors: Schmidt
mesh_terms: D019540:Area Under Curve; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000175:diagnosis*; D008297:Male; D015588:Observer Variation; D010808:Physical Examination / Q000379:methods*; D011446:Prospective Studies; D015203:Reproducibility of Results; D012140:Respiratory Tract Diseases / Q000175:diagnosis*
keywords: auscultation; bronchopulmonary dysplasia; physician prediction; retractions