{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T23:13:15Z","timestamp":1790723595458,"version":"4.1.0"},"reference-count":37,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2017,11,2]],"date-time":"2017-11-02T00:00:00Z","timestamp":1509580800000},"content-version":"vor","delay-in-days":0,"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":[[2017,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Investigators have derived cervical spine injury (<jats:styled-content style=\"fixed-case\">CSI<\/jats:styled-content>) decision support tools from physician observations. There is a need to demonstrate that prehospital emergency medical services (<jats:styled-content style=\"fixed-case\">EMS<\/jats:styled-content>) providers can use these tools to appropriately determine the need for spinal motion restrictions and make field disposition decisions.<\/jats:p><\/jats:sec><jats:sec><jats:title>Objectives<\/jats:title><jats:p>The objective was to determine the interobserver agreement between <jats:styled-content style=\"fixed-case\">EMS<\/jats:styled-content> and emergency department (<jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>) providers for <jats:styled-content style=\"fixed-case\">CSI<\/jats:styled-content> risk assessment variables and overall gestalt for <jats:styled-content style=\"fixed-case\">CSI<\/jats:styled-content> in children after blunt trauma.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a planned, substudy of a four\u2010site, prospective cohort of children\u00a0&lt;\u00a018 years transported by <jats:styled-content style=\"fixed-case\">EMS<\/jats:styled-content> to pediatric <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content>s for evaluation of <jats:styled-content style=\"fixed-case\">CSI<\/jats:styled-content> after blunt trauma. Inclusion criteria were trauma team activation and\/or <jats:styled-content style=\"fixed-case\">EMS<\/jats:styled-content>\u2010initiated spinal motion restriction. Exclusion criteria were penetrating trauma, transfer to another facility for definitive care, state custody, or substantial language barrier. For each eligible child, the transporting <jats:styled-content style=\"fixed-case\">EMS<\/jats:styled-content> provider and treating <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> provider independently recorded their clinical assessment for <jats:styled-content style=\"fixed-case\">CSI<\/jats:styled-content>. This included mechanism of injury and patient history and physical examination findings. We assessed each paired variable for interobserver agreement between <jats:styled-content style=\"fixed-case\">EMS<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> provider using kappa (\u03ba) analysis. We considered variables with \u03ba lower confidence interval values \u22650.4 to have moderate or better agreement.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>We obtained 1,372 paired observations for 29 variables. After finding prevalence and observer bias were adjusted for, all variables achieved moderate to better agreement including eight variables previously shown to be independently associated with <jats:styled-content style=\"fixed-case\">CSI<\/jats:styled-content> in children: diving mechanism, high\u2010risk motor vehicle collision, altered mental status, focal neurologic findings, neck pain, torticollis, substantial torso injury, and predisposing medical condition. <jats:styled-content style=\"fixed-case\">EMS<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> providers, however, showed less than moderate agreement for their overall gestalt for <jats:styled-content style=\"fixed-case\">CSI<\/jats:styled-content> in children. Of note, both <jats:styled-content style=\"fixed-case\">EMS<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> providers did not assess for neck pain, inability to move the neck, and\/or cervical spine tenderness in more than 10% of study patients.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Emergency medical services and <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> providers achieved at least moderate agreement in the assessment of <jats:styled-content style=\"fixed-case\">CSI<\/jats:styled-content> risk factors in children after blunt trauma. However, <jats:styled-content style=\"fixed-case\">EMS<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> providers did not achieve moderate agreement on gestalt for <jats:styled-content style=\"fixed-case\">CSI<\/jats:styled-content> and some risk factors went unassessed by providers. These findings support the development of a pediatric <jats:styled-content style=\"fixed-case\">CSI<\/jats:styled-content> risk assessment tool for <jats:styled-content style=\"fixed-case\">EMS<\/jats:styled-content> and <jats:styled-content style=\"fixed-case\">ED<\/jats:styled-content> providers to reduce interventions for those children at very low risk for <jats:styled-content style=\"fixed-case\">CSI<\/jats:styled-content>s while still identifying all children with injury.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.13312","type":"journal-article","created":{"date-parts":[[2017,9,18]],"date-time":"2017-09-18T14:37:16Z","timestamp":1505745436000},"page":"1501-1510","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":16,"title":["Interobserver Agreement in Pediatric Cervical Spine Injury Assessment Between Prehospital and Emergency Department Providers"],"prefix":"10.1111","volume":"24","author":[{"given":"Lorin R.","family":"Browne","sequence":"first","affiliation":[{"name":"Department of Pediatrics and Emergency Medicine Medical College of Wisconsin (LRB, EBL) Madison WI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamilton","family":"Schwartz","sequence":"additional","affiliation":[{"name":"Department of Pediatrics University of Cincinnati College of Medicine (HS) Cincinnati OH"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fahd A.","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Department Pediatrics Washington University School of Medicine in St. Louis St. Louis MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael","family":"Wallendorf","sequence":"additional","affiliation":[{"name":"Department of Biostatistics Washington University School of Medicine in St. Louis St. Louis MO"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nathan","family":"Kuppermann","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine and Pediatrics University of California Davis School of Medicine Sacramento CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E. Brooke","family":"Lerner","sequence":"additional","affiliation":[{"name":"Department of Pediatrics and Emergency Medicine Medical College of Wisconsin (LRB, EBL) Madison WI"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Julie C.","family":"Leonard","sequence":"additional","affiliation":[{"name":"Nationwide Children's Hospital and The Ohio State University College of Medicine Columbus OH"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2017,11,2]]},"reference":[{"key":"e_1_2_7_2_1","doi-asserted-by":"publisher","DOI":"10.3109\/10903127.2014.995850"},{"key":"e_1_2_7_3_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.108.2.e20"},{"key":"e_1_2_7_4_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2013-3505"},{"key":"e_1_2_7_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0020-1383(96)00115-5"},{"key":"e_1_2_7_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.1998.tb02615.x"},{"key":"e_1_2_7_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2044.1994.tb04254.x"},{"key":"e_1_2_7_8_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-198971010-00004"},{"key":"e_1_2_7_9_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e318289d743"},{"key":"e_1_2_7_10_1","doi-asserted-by":"publisher","DOI":"10.3109\/10903127.2012.689925"},{"key":"e_1_2_7_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(94)70032-X"},{"key":"e_1_2_7_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0196-0644(05)82983-X"},{"key":"e_1_2_7_13_1","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2006.041897"},{"key":"e_1_2_7_14_1","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1177\/000313481307901128","article-title":"Prehospital clinical clearance of the cervical spine: a prospective study","volume":"79","author":"Gonzalez RP","year":"2013","journal-title":"Am Surg"},{"key":"e_1_2_7_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2015.07.510"},{"key":"e_1_2_7_16_1","doi-asserted-by":"publisher","DOI":"10.3109\/10903127.2014.884197"},{"key":"e_1_2_7_17_1","unstructured":"National Model EMS Clinical Guidelines[Internet].National Association of State EMS Officials 2016. Available at:https:\/\/nasemso.org\/Projects\/ModelEMSClinicalGuidelines\/documents\/National-Model-EMS-Clinical-Guidelines-Aug2016.pdf. Accessed Jul 19 2017."},{"key":"e_1_2_7_18_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM200007133430203"},{"key":"e_1_2_7_19_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.b4146"},{"key":"e_1_2_7_20_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa031375"},{"key":"e_1_2_7_21_1","doi-asserted-by":"publisher","DOI":"10.1503\/cmaj.091430"},{"key":"e_1_2_7_22_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.286.15.1841"},{"key":"e_1_2_7_23_1","doi-asserted-by":"publisher","DOI":"10.1136\/emj.2009.089508"},{"key":"e_1_2_7_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2009.03.008"},{"key":"e_1_2_7_25_1","doi-asserted-by":"publisher","DOI":"10.1097\/BPO.0000000000000806"},{"key":"e_1_2_7_26_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000000298"},{"key":"e_1_2_7_27_1","doi-asserted-by":"publisher","DOI":"10.3109\/10903127.2015.1102997"},{"key":"e_1_2_7_28_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0b013e3181fc4088"},{"key":"e_1_2_7_29_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2010.08.038"},{"key":"e_1_2_7_30_1","first-page":"431","article-title":"Methods for collecting paired observations from emergency medical services and emergency department providers for pediatric cervical spine injury risk factors","volume":"24","author":"Ahmad F","year":"2016","journal-title":"Acad Emerg Med"},{"key":"e_1_2_7_31_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12923"},{"key":"e_1_2_7_32_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12739"},{"key":"e_1_2_7_33_1","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1093\/ptj\/85.3.257","article-title":"The kappa statistic in reliability studies","volume":"85","author":"Sim J","year":"2005","journal-title":"Phys Ther"},{"key":"e_1_2_7_34_1","doi-asserted-by":"publisher","DOI":"10.2307\/2529310"},{"key":"e_1_2_7_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.sapharm.2012.04.004"},{"key":"e_1_2_7_36_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2008.00206.x"},{"key":"e_1_2_7_37_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12132"},{"key":"e_1_2_7_38_1","doi-asserted-by":"publisher","DOI":"10.1111\/acem.12630"}],"container-title":["Academic Emergency Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2Facem.13312","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/acem.13312","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,29]],"date-time":"2023-09-29T14:55:59Z","timestamp":1695999359000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/acem.13312"}},"subtitle":[],"editor":[{"given":"Sabina A.","family":"Braithwaite","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2017,11,2]]},"references-count":37,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2017,12]]}},"alternative-id":["10.1111\/acem.13312"],"URL":"https:\/\/doi.org\/10.1111\/acem.13312","archive":["Portico"],"relation":{},"ISSN":["1069-6563","1553-2712"],"issn-type":[{"value":"1069-6563","type":"print"},{"value":"1553-2712","type":"electronic"}],"subject":[],"published":{"date-parts":[[2017,11,2]]},"assertion":[{"value":"2017-04-27","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-09-11","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2017-11-02","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}