Reliability of Clinical Assessments by Emergency Nurses and Physicians in the Evaluation of Dehydration in Children

2.50
Hdl Handle:
http://hdl.handle.net/10755/162605
Type:
Presentation
Title:
Reliability of Clinical Assessments by Emergency Nurses and Physicians in the Evaluation of Dehydration in Children
Abstract:
Reliability of Clinical Assessments by Emergency Nurses and Physicians in the Evaluation of Dehydration in Children
Conference Sponsor:Emergency Nurses Association
Conference Year:1995
Author:Murphy, Kathleen A.
P.I. Institution Name:Children's Hospital of Philadelphia
Contact Address:34th & Civic Center Blvd., Philadelphia, PA, 19104, USA
Co-Authors:Marc Gorelick
Purpose: Dehydration resulting from gastroenteritis or other acute illnesses is a common problem in pediatric emergency care. Accurate diagnosis, based on clinical signs and symptoms, is essential to make proper triage and treatment decision. Although these findings are somewhat subjective, there are no existing data examining the consistency of assessments by different observers. The purpose of this study was to determine the interobserver reliability between experienced emergency personnel in their clinical evaluation of the signs of dehydration in children.

Design/Setting: A cross-sectional concordance study was conducted at an urban, tertiary care pediatric emergency department (ED).

Sample: A convenience sample included 71 children age 2 weeks to 6 years seen in the ED with a chief complaint of vomiting, diarrhea, or poor oral fluid intake. Excluded were children with coexisting serious illness, or those treated at another healthcare facility.

Methodology: Study personnel included pediatric emergency nurses and physicians with minimum four year pediatric experience. Prior to therapy, each subject was independently evaluated by two study observers (nurse/nurse or nurse/physician) who completed a checklist of nine signs and symptoms based on the World Health Organization criteria: general appearance, respiratory patterns; radial pulse; sunken fontanelle; skin turgor; sunken eyes; absence of tears; humidity of mucous membrane; urine output; and capillary refill measurement according to a standardized protocol. Measures of reliability were determined, including the kappa statistic and the proportion of positive and negative agreement.

Result: Kappa, representing overall agreement corrected for chance, varied from 0.27 to 0.76 for the 10 clinical findings. Two of the findings, abnormal respiratory patterns and skin turgor, had unacceptably low kappas of less than 0.35. Kappa was very similar when nurse/nurse pairs and nurse/physician pairs were analyzed separately. For all findings, specific agreement was greater than overall agreement: proportion of positive agreement ranged from 0.33 to 0.89, while proportion of negative agreement ranged from 0.85 to 0.95.

Conclusion: There is some variability in the assessment signs of dehydration even by experienced observers; however, the level of agreement is acceptable for the most commonly elicited findings. Both nurses and physicians show a similar degree of consistency. Nursing assessments of children at risk for dehydration should emphasize those clinical findings with acceptable interobserver reliability. [Research Poster Presentation]
Repository Posting Date:
27-Oct-2011
Date of Publication:
17-Oct-2011
Sponsors:
Emergency Nurses Association

Full metadata record

DC FieldValue Language
dc.typePresentationen_GB
dc.titleReliability of Clinical Assessments by Emergency Nurses and Physicians in the Evaluation of Dehydration in Childrenen_GB
dc.identifier.urihttp://hdl.handle.net/10755/162605-
dc.description.abstract<table><tr><td colspan="2" class="item-title">Reliability of Clinical Assessments by Emergency Nurses and Physicians in the Evaluation of Dehydration in Children</td></tr><tr class="item-sponsor"><td class="label">Conference Sponsor:</td><td class="value">Emergency Nurses Association</td></tr><tr class="item-year"><td class="label">Conference Year:</td><td class="value">1995</td></tr><tr class="item-author"><td class="label">Author:</td><td class="value">Murphy, Kathleen A.</td></tr><tr class="item-institute"><td class="label">P.I. Institution Name:</td><td class="value">Children's Hospital of Philadelphia</td></tr><tr class="item-address"><td class="label">Contact Address:</td><td class="value">34th &amp; Civic Center Blvd., Philadelphia, PA, 19104, USA</td></tr><tr class="item-email"><td class="label">Email:</td><td class="value">res@ena.org</td></tr><tr class="item-co-authors"><td class="label">Co-Authors:</td><td class="value">Marc Gorelick</td></tr><tr><td colspan="2" class="item-abstract">Purpose: Dehydration resulting from gastroenteritis or other acute illnesses is a common problem in pediatric emergency care. Accurate diagnosis, based on clinical signs and symptoms, is essential to make proper triage and treatment decision. Although these findings are somewhat subjective, there are no existing data examining the consistency of assessments by different observers. The purpose of this study was to determine the interobserver reliability between experienced emergency personnel in their clinical evaluation of the signs of dehydration in children.<br/><br/>Design/Setting: A cross-sectional concordance study was conducted at an urban, tertiary care pediatric emergency department (ED).<br/><br/>Sample: A convenience sample included 71 children age 2 weeks to 6 years seen in the ED with a chief complaint of vomiting, diarrhea, or poor oral fluid intake. Excluded were children with coexisting serious illness, or those treated at another healthcare facility.<br/><br/>Methodology: Study personnel included pediatric emergency nurses and physicians with minimum four year pediatric experience. Prior to therapy, each subject was independently evaluated by two study observers (nurse/nurse or nurse/physician) who completed a checklist of nine signs and symptoms based on the World Health Organization criteria: general appearance, respiratory patterns; radial pulse; sunken fontanelle; skin turgor; sunken eyes; absence of tears; humidity of mucous membrane; urine output; and capillary refill measurement according to a standardized protocol. Measures of reliability were determined, including the kappa statistic and the proportion of positive and negative agreement.<br/><br/>Result: Kappa, representing overall agreement corrected for chance, varied from 0.27 to 0.76 for the 10 clinical findings. Two of the findings, abnormal respiratory patterns and skin turgor, had unacceptably low kappas of less than 0.35. Kappa was very similar when nurse/nurse pairs and nurse/physician pairs were analyzed separately. For all findings, specific agreement was greater than overall agreement: proportion of positive agreement ranged from 0.33 to 0.89, while proportion of negative agreement ranged from 0.85 to 0.95.<br/><br/>Conclusion: There is some variability in the assessment signs of dehydration even by experienced observers; however, the level of agreement is acceptable for the most commonly elicited findings. Both nurses and physicians show a similar degree of consistency. Nursing assessments of children at risk for dehydration should emphasize those clinical findings with acceptable interobserver reliability. [Research Poster Presentation]</td></tr></table>en_GB
dc.date.available2011-10-27T10:31:00Z-
dc.date.issued2011-10-17en_GB
dc.date.accessioned2011-10-27T10:31:00Z-
dc.description.sponsorshipEmergency Nurses Associationen_GB
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