Reliability of examination findings in suspected community-acquired pneumonia

Todd A. Florin*, Lilliam Ambroggio, Cole Brokamp, Mantosh S. Rattan, Eric J. Crotty, Andrea Kachelmeyer, Richard M. Ruddy, Samir S. Shah

*Corresponding author for this work

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

BACKGROUND: The authors of national guidelines emphasize the use of history and examination findings to diagnose community-acquired pneumonia (CAP) in outpatient children. Little is known about the interrater reliability of the physical examination in children with suspected CAP. METHODS: This was a prospective cohort study of children with suspected CAP presenting to a pediatric emergency department from July 2013 to May 2016. Children aged 3 months to 18 years with lower respiratory signs or symptoms who received a chest radiograph were included. We excluded children hospitalized ≤14 days before the study visit and those with a chronic medical condition or aspiration. Two clinicians performed independent examinations and completed identical forms reporting examination findings. Interrater reliability for each finding was reported by using Fleiss' kappa (κ) for categorical variables and intraclass correlation coefficient (ICC) for continuous variables. RESULTS: No examination finding had substantial agreement (κ/ICC > 0.8). Two findings (retractions, wheezing) had moderate to substantial agreement (κ/ICC = 0.6-0.8). Nine findings (abdominal pain, pleuritic pain, nasal flaring, skin color, overall impression, cool extremities, tachypnea, respiratory rate, and crackles/rales) had fair to moderate agreement (κ/ICC = 0.4-0.6). Eight findings (capillary refill time, cough, rhonchi, head bobbing, behavior, grunting, general appearance, and decreased breath sounds) had poor to fair reliability (κ/ICC = 0-0.4). Only 3 examination findings had acceptable agreement, with the lower 95% confidence limit >0.4: wheezing, retractions, and respiratory rate. CONCLUSIONS: In this study, we found fair to moderate reliability of many findings used to diagnose CAP. Only 3 findings had acceptable levels of reliability. These findings must be considered in the clinical management and research of pediatric CAP.

Original languageEnglish (US)
Article numbere20170310
JournalPediatrics
Volume140
Issue number3
DOIs
StatePublished - Sep 1 2017

Fingerprint

Respiratory Sounds
Pneumonia
Respiratory Rate
Respiratory Signs and Symptoms
Pediatrics
Skin Pigmentation
Tachypnea
Hospitalized Child
Nose
Cough
Abdominal Pain
Physical Examination
Hospital Emergency Service
Cohort Studies
Outpatients
Thorax
Extremities
History
Head
Prospective Studies

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Florin, T. A., Ambroggio, L., Brokamp, C., Rattan, M. S., Crotty, E. J., Kachelmeyer, A., ... Shah, S. S. (2017). Reliability of examination findings in suspected community-acquired pneumonia. Pediatrics, 140(3), [e20170310]. https://doi.org/10.1542/peds.2017-0310
Florin, Todd A. ; Ambroggio, Lilliam ; Brokamp, Cole ; Rattan, Mantosh S. ; Crotty, Eric J. ; Kachelmeyer, Andrea ; Ruddy, Richard M. ; Shah, Samir S. / Reliability of examination findings in suspected community-acquired pneumonia. In: Pediatrics. 2017 ; Vol. 140, No. 3.
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title = "Reliability of examination findings in suspected community-acquired pneumonia",
abstract = "BACKGROUND: The authors of national guidelines emphasize the use of history and examination findings to diagnose community-acquired pneumonia (CAP) in outpatient children. Little is known about the interrater reliability of the physical examination in children with suspected CAP. METHODS: This was a prospective cohort study of children with suspected CAP presenting to a pediatric emergency department from July 2013 to May 2016. Children aged 3 months to 18 years with lower respiratory signs or symptoms who received a chest radiograph were included. We excluded children hospitalized ≤14 days before the study visit and those with a chronic medical condition or aspiration. Two clinicians performed independent examinations and completed identical forms reporting examination findings. Interrater reliability for each finding was reported by using Fleiss' kappa (κ) for categorical variables and intraclass correlation coefficient (ICC) for continuous variables. RESULTS: No examination finding had substantial agreement (κ/ICC > 0.8). Two findings (retractions, wheezing) had moderate to substantial agreement (κ/ICC = 0.6-0.8). Nine findings (abdominal pain, pleuritic pain, nasal flaring, skin color, overall impression, cool extremities, tachypnea, respiratory rate, and crackles/rales) had fair to moderate agreement (κ/ICC = 0.4-0.6). Eight findings (capillary refill time, cough, rhonchi, head bobbing, behavior, grunting, general appearance, and decreased breath sounds) had poor to fair reliability (κ/ICC = 0-0.4). Only 3 examination findings had acceptable agreement, with the lower 95{\%} confidence limit >0.4: wheezing, retractions, and respiratory rate. CONCLUSIONS: In this study, we found fair to moderate reliability of many findings used to diagnose CAP. Only 3 findings had acceptable levels of reliability. These findings must be considered in the clinical management and research of pediatric CAP.",
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Florin, TA, Ambroggio, L, Brokamp, C, Rattan, MS, Crotty, EJ, Kachelmeyer, A, Ruddy, RM & Shah, SS 2017, 'Reliability of examination findings in suspected community-acquired pneumonia', Pediatrics, vol. 140, no. 3, e20170310. https://doi.org/10.1542/peds.2017-0310

Reliability of examination findings in suspected community-acquired pneumonia. / Florin, Todd A.; Ambroggio, Lilliam; Brokamp, Cole; Rattan, Mantosh S.; Crotty, Eric J.; Kachelmeyer, Andrea; Ruddy, Richard M.; Shah, Samir S.

In: Pediatrics, Vol. 140, No. 3, e20170310, 01.09.2017.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Reliability of examination findings in suspected community-acquired pneumonia

AU - Florin, Todd A.

AU - Ambroggio, Lilliam

AU - Brokamp, Cole

AU - Rattan, Mantosh S.

AU - Crotty, Eric J.

AU - Kachelmeyer, Andrea

AU - Ruddy, Richard M.

AU - Shah, Samir S.

PY - 2017/9/1

Y1 - 2017/9/1

N2 - BACKGROUND: The authors of national guidelines emphasize the use of history and examination findings to diagnose community-acquired pneumonia (CAP) in outpatient children. Little is known about the interrater reliability of the physical examination in children with suspected CAP. METHODS: This was a prospective cohort study of children with suspected CAP presenting to a pediatric emergency department from July 2013 to May 2016. Children aged 3 months to 18 years with lower respiratory signs or symptoms who received a chest radiograph were included. We excluded children hospitalized ≤14 days before the study visit and those with a chronic medical condition or aspiration. Two clinicians performed independent examinations and completed identical forms reporting examination findings. Interrater reliability for each finding was reported by using Fleiss' kappa (κ) for categorical variables and intraclass correlation coefficient (ICC) for continuous variables. RESULTS: No examination finding had substantial agreement (κ/ICC > 0.8). Two findings (retractions, wheezing) had moderate to substantial agreement (κ/ICC = 0.6-0.8). Nine findings (abdominal pain, pleuritic pain, nasal flaring, skin color, overall impression, cool extremities, tachypnea, respiratory rate, and crackles/rales) had fair to moderate agreement (κ/ICC = 0.4-0.6). Eight findings (capillary refill time, cough, rhonchi, head bobbing, behavior, grunting, general appearance, and decreased breath sounds) had poor to fair reliability (κ/ICC = 0-0.4). Only 3 examination findings had acceptable agreement, with the lower 95% confidence limit >0.4: wheezing, retractions, and respiratory rate. CONCLUSIONS: In this study, we found fair to moderate reliability of many findings used to diagnose CAP. Only 3 findings had acceptable levels of reliability. These findings must be considered in the clinical management and research of pediatric CAP.

AB - BACKGROUND: The authors of national guidelines emphasize the use of history and examination findings to diagnose community-acquired pneumonia (CAP) in outpatient children. Little is known about the interrater reliability of the physical examination in children with suspected CAP. METHODS: This was a prospective cohort study of children with suspected CAP presenting to a pediatric emergency department from July 2013 to May 2016. Children aged 3 months to 18 years with lower respiratory signs or symptoms who received a chest radiograph were included. We excluded children hospitalized ≤14 days before the study visit and those with a chronic medical condition or aspiration. Two clinicians performed independent examinations and completed identical forms reporting examination findings. Interrater reliability for each finding was reported by using Fleiss' kappa (κ) for categorical variables and intraclass correlation coefficient (ICC) for continuous variables. RESULTS: No examination finding had substantial agreement (κ/ICC > 0.8). Two findings (retractions, wheezing) had moderate to substantial agreement (κ/ICC = 0.6-0.8). Nine findings (abdominal pain, pleuritic pain, nasal flaring, skin color, overall impression, cool extremities, tachypnea, respiratory rate, and crackles/rales) had fair to moderate agreement (κ/ICC = 0.4-0.6). Eight findings (capillary refill time, cough, rhonchi, head bobbing, behavior, grunting, general appearance, and decreased breath sounds) had poor to fair reliability (κ/ICC = 0-0.4). Only 3 examination findings had acceptable agreement, with the lower 95% confidence limit >0.4: wheezing, retractions, and respiratory rate. CONCLUSIONS: In this study, we found fair to moderate reliability of many findings used to diagnose CAP. Only 3 findings had acceptable levels of reliability. These findings must be considered in the clinical management and research of pediatric CAP.

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Florin TA, Ambroggio L, Brokamp C, Rattan MS, Crotty EJ, Kachelmeyer A et al. Reliability of examination findings in suspected community-acquired pneumonia. Pediatrics. 2017 Sep 1;140(3). e20170310. https://doi.org/10.1542/peds.2017-0310