Pediatric Blunt Abdominal Trauma: Interobserver Agreement of Historical and Physical Findings
Agreement was at least fair for most variables, but the study provides no information on their predictive ability for intra-abdominal injury.
Investigators evaluated interobserver agreement for historical and physical exam findings in 632 children (mean age, 10 years) with blunt torso trauma who presented to the 20 emergency departments in the Pediatric Emergency Care Applied Research Network (PECARN) during a 3-year period. Two clinicians (attendings or fellows in general emergency medicine, pediatric emergency medicine, pediatrics, or surgery) independently evaluated each patient within 60 minutes of each other, before laboratory and imaging results were known.
As determined using a kappa statistic with pre-defined cutoffs, interobserver agreement was acceptable for injury mechanism; complaint of abdominal pain; presence, location, and degree of abdominal tenderness; vomiting/retching; presence of a distracting painful injury; seat belt sign; abdominal wall trauma; thoracic trauma or tenderness; abdominal distension; and pelvic bone tenderness. Agreement was poor for flank tenderness, abnormal chest auscultation, pelvis instability, absence of bowel sounds, suspicion of alcohol or drug intoxication, and peritoneal irritation.
COMMENT
Clinicians combine history and physical examination findings to establish a likelihood of injury, so the value of any one finding, even if highly consistent between examiners, is questionable. There is no evidence to support reliance on any one of these historical or examination elements more than any other.
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