Reliability of clinical examinations for pediatric skin and soft-tissue infections

Jennifer R. Marin, Warren Bilker, Ebbing Lautenbach, Elizabeth R. Alpern

Research output: Contribution to journalArticlepeer-review

42 Scopus citations


OBJECTIVE: To determine the interrater reliability of clinical examination by pediatric emergency medicine physicians for the diagnosis of skin and soft-tissue infections (SSTIs). METHODS: A cross-sectional study of patients presenting to a pediatric emergency department with SSTIs was performed. Each lesion was examined by a treating physician and a study physician (from a pool of 62 physicians) at the bedside during the emergency department visit. The primary outcome was reliability, as measured with the weighted κ statistic, for determining whether the lesion was an abscess and whether the lesion required a drainage procedure. RESULTS: A total of 371 lesions were analyzed for interrater reliability. The weighted κ value for diagnosis of the lesion as an abscess was 0.39 (95% confidence interval: 0.32-0.47), and that for assessment of the need for drainage was 0.43 (95% confidence interval: 0.36-0.51). Agreement was statistically more likely for lesions in children ≥4 years of age but was not more likely for lesions in nonblack patients, lesions in patients with a history of or exposure to a close contact with a SSTI, or lesions examined by 2 experienced pediatric emergency medicine physicians. CONCLUSIONS: Among the 62 participating physicians at our site, the reliability of the clinical examination was poor. This may indicate that improved education and/or more-objective means for diagnosing these infections in the acute care setting are warranted. Additional studies are needed to determine whether these results are generalizable to other settings.

Original languageEnglish (US)
Pages (from-to)925-930
Number of pages6
Issue number5
StatePublished - Nov 2010


  • Reliability
  • Skin and soft-tissue infections

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health


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