Reliability of routinely collected anthropometric measurements in primary care

Abstract

Background: Measuring body mass index (BMI) has been proposed as a method of screening for preventive primary care and population surveillance of childhood obesity. However, the accuracy of routinely collected measurements has been questioned. The purpose of this study was to assess the reliability of height, length and weight measurements collected during well-child visits in primary care relative to trained research personnel.

Methods: A cross-sectional study of measurement reliability was conducted in community pediatric and family medicine primary care practices. Each participating child, ages 0 to 18 years, was measured four consecutive times; twice by a primary care team member (e.g. nurses, practice personnel) and twice by a trained research assistant. Inter- and intra-observer reliability was calculated using the technical error of measurement (TEM), relative TEM (%TEM), and a coefficient of reliability (R).

Results: Six trained research assistants and 16 primary care team members performed measurements in three practices. All %TEM values for intra-observer reliability of length, height, and weight were classified as 'acceptable' (< 2%; range 0.19% to 0.70%). Inter-observer reliability was also classified as 'acceptable' (< 2%; range 0.36% to 1.03%) for all measurements. Coefficients of reliability (R) were all > 99% for both intra- and inter-observer reliability. Length measurements in children < 2 years had the highest measurement error. There were some significant differences in length intra-observer reliability between observers.

Conclusion: There was agreement between routine measurements and research measurements although there were some differences in length measurement reliability between practice staff and research assistants. These results provide justification for using routinely collected data from selected primary care practices for secondary purposes such as BMI population surveillance and research.

Keywords: Childhood obesity; Growth; Height; Measurement; Reliability; TEM; Weight.

Fig. 1

Bland-Altman plots on the weight and length/height measurements for intra- and inter-observer reliability by age group. Top row of plots: a) inter-observer reliability for weight 0- < 2 years, b) intra-observer reliability weight 0- < 2, c) inter-observer reliability for weight 2–18 years, d) intra-observer reliability for weight 2–18 years, e) inter-observer reliability for length 0- < 2 years, f) intra-observer reliability for length 0- < 2 years, g) inter-observer reliability height 2–18 years, h) intra-observer reliability for height 2–18 years