PMID- 32988814 OWN - NLM STAT- MEDLINE DCOM- 20210222 LR - 20210222 IS - 1468-2044 (Electronic) IS - 0003-9888 (Print) IS - 0003-9888 (Linking) VI - 106 IP - 2 DP - 2021 Feb TI - Inter-rater reliability of paediatric emergency assessment: physiological and clinical features. PG - 149-153 LID - 10.1136/archdischild-2019-318664 [doi] AB - OBJECTIVE: The Paediatric Admission Guidance in the Emergency Department (PAGE) score is an assessment tool currently in development that helps predict hospital admission using components including patient characteristics, vital signs (heart rate, temperature, respiratory rate and oxygen saturation) and clinical features (eg, breathing, behaviour and nurse judgement). It aims to assist in safe admission and discharge decision making in environments such as emergency departments and urgent care centres. Determining the inter-rater reliability of scoring tools such as PAGE can be difficult. The aim of this study was to determine the inter-rater reliability of seven clinical components of the PAGE Score. DESIGN: Inter-rater reliability was measured by each patient having their clinical components recorded by two separate raters in succession. The first rater was the assessing nurse, and the second rater was a research nurse. SETTING: Two emergency departments and one urgent care centre in the North West of England. Measurements were recorded over 1 week; data were collected for half a day at each of the three sites. PATIENTS: A convenience sample of 90 paediatric attendees (aged 0-16 years), 30 from each of the three sites. MAIN OUTCOME MEASURES: Two independent measures for each child were compared using kappa or prevalence-adjusted bias-adjusted kappa (PABAK). Bland-Altman plots were also constructed for continuous measurements. RESULTS: Inter-rater reliability ranged from moderate (0.62 (95% CI 0.48 to 0.74) weighted kappa) to very good (0.98 (95% CI 95 to 0.99) weighted kappa) for all measurements except 'nurse judgement' for which agreement was fair (0.30, 95% CI 0.09 to 0.50 PABAK). Complete information from both raters on all the clinical components of the PAGE score were available for 73 children (81%). These total scores showed good' inter-rater reliability (0.64 (95% CI 0.53 to 0.74) weighted kappa). CONCLUSIONS: Our findings suggest different nurses would demonstrate good inter-rater reliability when collecting acute assessments needed for the PAGE score, reinforcing the applicability of the tool. The importance of determining reliability in scoring systems is highlighted and a suitable methodology was presented. CI - (c) Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY. Published by BMJ. FAU - Heal, Calvin AU - Heal C AUID- ORCID: 0000-0002-6445-1551 AD - Centre for Biostatistics, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK calvin.heal@manchester.ac.uk. FAU - Cotterill, Sarah AU - Cotterill S AD - Centre for Biostatistics, The University of Manchester Faculty of Biology Medicine and Health, Manchester, UK. FAU - Rowland, Andrew Graeme AU - Rowland AG AD - School of Health and Society, The University of Salford, Salford, UK. AD - Emergency Department, North Manchester General Hospital, Manchester, UK. FAU - Garratt, Natalie AU - Garratt N AD - Northern Care Alliance NHS Group, Salford, UK. FAU - Long, Tony AU - Long T AUID- ORCID: 0000-0003-2726-8798 AD - School of Health and Society, The University of Salford, Salford, UK. FAU - Brown, Stephen AU - Brown S AD - Northern Care Alliance NHS Group, Salford, UK. FAU - O'Connor, Grainne AU - O'Connor G AD - Northern Care Alliance NHS Group, Salford, UK. FAU - Rishton, Chloe AU - Rishton C AD - Northern Care Alliance NHS Group, Salford, UK. FAU - Woby, Steve AU - Woby S AD - Northern Care Alliance NHS Group, Salford, UK. FAU - Roland, Damian AU - Roland D AUID- ORCID: 0000-0001-9334-5144 AD - Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Leicester Royal Infirmary, Leicester, UK. AD - SAPHIRE Group, University of Leicester, Leicester, UK. LA - eng GR - PB-PG-0815-20034/DH_/Department of Health/United Kingdom PT - Journal Article PT - Multicenter Study PT - Research Support, Non-U.S. Gov't PT - Validation Study DEP - 20200928 PL - England TA - Arch Dis Child JT - Archives of disease in childhood JID - 0372434 SB - IM MH - Adolescent MH - Child MH - Child, Preschool MH - *Emergencies MH - Emergency Medical Services/*standards MH - Emergency Service, Hospital MH - England MH - Female MH - Humans MH - Infant MH - Infant, Newborn MH - Male MH - Observer Variation MH - Reproducibility of Results MH - *Severity of Illness Index MH - State Medicine PMC - PMC7841473 OTO - NOTNLM OT - accident & emergency OT - general paediatrics OT - paediatric practice COIS- Competing interests: None declared. EDAT- 2020/09/30 06:00 MHDA- 2021/02/23 06:00 PMCR- 2021/01/28 CRDT- 2020/09/29 05:30 PHST- 2019/12/10 00:00 [received] PHST- 2020/07/14 00:00 [revised] PHST- 2020/07/15 00:00 [accepted] PHST- 2020/09/30 06:00 [pubmed] PHST- 2021/02/23 06:00 [medline] PHST- 2020/09/29 05:30 [entrez] PHST- 2021/01/28 00:00 [pmc-release] AID - archdischild-2019-318664 [pii] AID - 10.1136/archdischild-2019-318664 [doi] PST - ppublish SO - Arch Dis Child. 2021 Feb;106(2):149-153. doi: 10.1136/archdischild-2019-318664. Epub 2020 Sep 28.