{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T21:30:16Z","timestamp":1792099816610,"version":"4.4.0"},"reference-count":25,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2013,5,14]],"date-time":"2013-05-14T00:00:00Z","timestamp":1368489600000},"content-version":"vor","delay-in-days":13,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2013,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The objective was to determine the interobserver agreement of historical and physical examination findings assessed during the emergency department (ED) evaluation of children with blunt abdominal trauma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a planned substudy of a multicenter, prospective cohort study of children younger than 18\u00a0years of age evaluated for blunt abdominal trauma. Patients were excluded if injury occurred more than 24\u00a0hours prior to evaluation or if computed tomography (CT) imaging was obtained at another hospital prior to transfer to a study site. Two clinicians independently recorded their clinical assessments of a convenience sample of patients onto data collection forms within 60 minutes of each other and prior to CT imaging (if obtained) or knowledge of laboratory results. The authors categorized variables as either subjective symptoms (i.e., patient history) or objective findings (i.e., physical examination). For each variable recorded by the two observers, the agreement beyond that expected by chance was estimated, using the kappa (\u03ba) statistic for categorical variables and weighted \u03ba for ordinal variables. Variables with 95% lower confidence limits (LCLs) \u03ba \u2265 0.4 (moderate agreement or better) were considered to have acceptable agreement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 632 pairs of physician observations were obtained on 23 candidate variables. Acceptable agreement was achieved in 16 (70%) of the 23 variables tested. For six subjective symptoms, \u03ba ranged from 0.48 (complaint of shortness of breath) to 0.90 (mechanism of injury), and only the complaint of shortness of breath had a 95% LCL \u03ba\u00a0&lt;\u00a00.4. For the 17 objective findings, \u03ba ranged from \u20130.01 (pelvis instability) to 0.82 (seat belt sign present). The 95% LCL for \u03ba was\u00a0&lt;0.4 for flank tenderness, abnormal chest auscultation, suspicion of alcohol or drug intoxication, pelvis instability, absence of bowel sounds, and peritoneal irritation.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Observers can achieve at least acceptable agreement on the majority of historical and physical examination variables in children with blunt abdominal trauma evaluated in the ED. Those variables are candidates for consideration for development of a clinical prediction rule for intra\u2010abdominal injury in children with blunt trauma.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.12132","type":"journal-article","created":{"date-parts":[[2013,5,14]],"date-time":"2013-05-14T11:59:48Z","timestamp":1368532788000},"page":"426-432","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":30,"title":["Interobserver Agreement in the Clinical Assessment of Children With Blunt Abdominal Trauma"],"prefix":"10.1111","volume":"20","author":[{"given":"Kenneth","family":"Yen","sequence":"first","affiliation":[{"name":"Department of Pediatrics Section of Emergency Medicine Medical College of Wisconsin  Milwaukee WI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Kuppermann","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of California Davis School of Medicine  Sacramento CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathleen","family":"Lillis","sequence":"additional","affiliation":[{"name":"the Department of Pediatrics Division of Emergency Medicine State University of New York at Buffalo Women and Children's Hospital of Buffalo  Buffalo NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Monroe","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Howard County General Hospital  Columbia MD"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dominic","family":"Borgialli","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Michigan Hurley Medical Center  Flint MI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin T.","family":"Kerrey","sequence":"additional","affiliation":[{"name":"the Department of Pediatrics Division of Emergency Medicine University of Cincinnati College of Medicine  Cincinnati OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter E.","family":"Sokolove","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of California Davis School of Medicine  Sacramento CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angela M.","family":"Ellison","sequence":"additional","affiliation":[{"name":"Department of Pediatrics Division of Emergency Medicine Perelman School of Medicine University of Pennsylvania  Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence J.","family":"Cook","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Utah  Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James F.","family":"Holmes","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of California Davis School of Medicine  Sacramento CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"The Intra\u2010abdominal Injury Study Group for the Pediatric Emergency Care Applied Research Network (PECARN)","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2013,5,14]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2011-3435"},{"key":"e_1_2_8_3_1","unstructured":"American College of Surgeons Committee on Trauma.National Trauma Database 2011: Pediatric Report. 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