Interrater reliability between surgeons and pediatric emergency providers in the cervical spine assessment of injured children.

IF 2.9 2区医学 Q2 CRITICAL CARE MEDICINE

Journal of Trauma and Acute Care Surgery Pub Date : 2025-06-19 DOI:10.1097/TA.0000000000004695

Fahd A Ahmad, Lorin R Browne, Nicolaus W Glomb, Monica Harding, Lawrence J Cook, Rebecca K Burger, Pradip P Chaudhari, Alexander J Rogers, Caleb E Ward, Daniel Rubalcava, Kenneth Yen, Nathan Kuppermann, Julie C Leonard

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引用次数: 0

Abstract

Background: Cervical spine injury (CSI) is uncommon in children but an important consideration during trauma evaluation. The Pediatric Emergency Care Applied Research Network (PECARN) derived and validated a CSI prediction rule to guide cervical spine imaging decisions in children after blunt trauma. Our objective was to determine the interrater reliability between EM providers and surgeons for history and physical examination findings used to evaluate children for CSI after blunt trauma.

Methods: This was a planned secondary analysis of a prospective, observational multicenter study that enrolled children aged 0 year to 17 years evaluated for blunt trauma in 18 PECARN emergency departments (EDs). We collected data on injury mechanisms, history and physical examination findings, imaging ordered, and suspicion of CSI from EM and surgery providers. Kappa, prevalence, and bias-adjusted kappa (PABAK) were used to compare interrater reliability of variables associated with CSI.

Results: Surgeons cared for 8,041 of the 22,430 children enrolled in the parent study. About 18.6% (1494/8041) had data collection forms completed by both EM providers and surgeons and were included in the analysis. Agreement between EM and surgery providers per kappa was moderate (kappa 0.41-0.6) to substantial (kappa 0.61-0.8), while PABAK analyses showed substantial to almost perfect agreement for variables in the PECARN CSI prediction rule. There was agreement between EM and surgery providers in overall clinical suspicion for CSI in 64.2% (959/1494) of patients. Retrospective application of the PECARN Rule indicated that ED and surgical provider assessments would have led to the same imaging decision in 73.7% (1101/1494) of patients.

Conclusion: We identified moderate to substantial agreement between EM providers and surgeons for clinical findings that comprise the PECARN Cervical Spine Injury Prediction Rule. Agreement between providers during shared decision-making will strengthen the use of the prediction rule and may lead to decreased cervical spine imaging in EDs.

Level of evidence: Prognostic and Epidemiologic; Level II.

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在受伤儿童颈椎评估中，外科医生和儿科急诊提供者之间的相互可靠性。

背景：颈椎损伤（CSI）在儿童中并不常见，但却是创伤评估的重要考虑因素。儿科急诊应用研究网络（PECARN）推导并验证了CSI预测规则，以指导钝性创伤后儿童颈椎影像学决策。我们的目的是确定急诊医生和外科医生在评估钝性创伤后儿童CSI的病史和体格检查结果方面的相互可靠性。方法：这是一项前瞻性、观察性多中心研究的计划二次分析，该研究纳入了18个PECARN急诊科（ed）评估钝性创伤的0至17岁儿童。我们收集了损伤机制、病史和体格检查结果、影像学要求以及EM和外科医生对CSI的怀疑的数据。使用Kappa、患病率和偏差校正Kappa （PABAK）来比较与CSI相关的变量的间信度。结果：在22,430名参加父母研究的儿童中，外科医生照顾了8,041名儿童。约18.6%（1494/8041）有由急诊医生和外科医生填写的数据收集表，并被纳入分析。EM和外科医生之间的一致性从kappa的中等（kappa 0.41-0.6）到显著（kappa 0.61-0.8），而PABAK分析显示PECARN CSI预测规则中变量的一致性从显著到几乎完美。在64.2%（959/1494）的患者中，急诊医生和外科医生对CSI的总体临床怀疑是一致的。PECARN规则的回顾性应用表明，在73.7%（1101/1494）的患者中，ED和外科医生的评估会导致相同的影像学决定。结论：我们确定了EM提供者和外科医生对PECARN颈椎损伤预测规则的临床发现有中度到实质性的一致。在共同决策过程中，提供者之间的协议将加强预测规则的使用，并可能导致急诊科颈椎成像下降。证据水平：预后和流行病学；II级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Trauma and Acute Care Surgery 医学-外科

CiteScore

6.00

自引率

11.80%

发文量

637

审稿时长

2.7 months

期刊介绍： The Journal of Trauma and Acute Care Surgery® is designed to provide the scientific basis to optimize care of the severely injured and critically ill surgical patient. Thus, the Journal has a high priority for basic and translation research to fulfill this objectives. Additionally, the Journal is enthusiastic to publish randomized prospective clinical studies to establish care predicated on a mechanistic foundation. Finally, the Journal is seeking systematic reviews, guidelines and algorithms that incorporate the best evidence available.