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Observational Study
. 2025 Dec 1;99(6):876-883.
doi: 10.1097/TA.0000000000004695. Epub 2025 Jun 19.

Interrater reliability between surgeons and pediatric emergency providers in the cervical spine assessment of injured children

Fahd A Ahmad  1 , Lorin R Browne, Nicolaus W Glomb, Monica Harding, Lawrence J Cook, Rebecca K Burger, Pradip P Chaudhari, Alexander J Rogers, Caleb E Ward, Daniel Rubalcava, Kenneth Yen, Nathan Kuppermann, Julie C Leonard
Affiliations
Observational Study

Interrater reliability between surgeons and pediatric emergency providers in the cervical spine assessment of injured children

Fahd A Ahmad et al. J Trauma Acute Care Surg. .

Abstract

Background: Cervical spine injury (CSI) is uncommon in children but an important consideration during trauma evaluation. The Pediatric Emergency Care Applied Research Network (PECARN) derived and validated a CSI prediction rule to guide cervical spine imaging decisions in children after blunt trauma. Our objective was to determine the interrater reliability between EM providers and surgeons for history and physical examination findings used to evaluate children for CSI after blunt trauma.

Methods: This was a planned secondary analysis of a prospective, observational multicenter study that enrolled children aged 0 year to 17 years evaluated for blunt trauma in 18 PECARN emergency departments (EDs). We collected data on injury mechanisms, history and physical examination findings, imaging ordered, and suspicion of CSI from EM and surgery providers. Kappa, prevalence, and bias-adjusted kappa (PABAK) were used to compare interrater reliability of variables associated with CSI.

Results: Surgeons cared for 8,041 of the 22,430 children enrolled in the parent study. About 18.6% (1494/8041) had data collection forms completed by both EM providers and surgeons and were included in the analysis. Agreement between EM and surgery providers per kappa was moderate (kappa 0.41-0.6) to substantial (kappa 0.61-0.8), while PABAK analyses showed substantial to almost perfect agreement for variables in the PECARN CSI prediction rule. There was agreement between EM and surgery providers in overall clinical suspicion for CSI in 64.2% (959/1494) of patients. Retrospective application of the PECARN Rule indicated that ED and surgical provider assessments would have led to the same imaging decision in 73.7% (1101/1494) of patients.

Conclusion: We identified moderate to substantial agreement between EM providers and surgeons for clinical findings that comprise the PECARN Cervical Spine Injury Prediction Rule. Agreement between providers during shared decision-making will strengthen the use of the prediction rule and may lead to decreased cervical spine imaging in EDs.

Level of evidence: Prognostic and Epidemiologic; Level III.

Keywords: Cervical spine injury; emergency medicine; interrater reliability; pediatric; surgeon.

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References

    1. Kokoska ER, Keller MS, Rallo MC, Weber TR. Characteristics of pediatric cervical spine injuries. J Pediatr Surg . 2001;36(1):100–105.
    1. National Association of state EMS officials. National Model EMS Clinical Guidelines 2022 [updated March 2022. Available from: https://nasemso.org/wp-content/uploads/National-Model-EMS-Clinical-Guide... .
    1. American College of Surgeons. Best Practice Guidelines — Spine Injury 2022 [updated March 2022. Available from: https://www.facs.org/media/k45gikqv/spine_injury_guidelines.pdf .
    1. Gregory ME, Truelove A, Ahmad F, Corwin D, Tzimenatos L, Oglesbee SJ, et al. Decision-making for pediatric cervical spine imaging after blunt trauma: investigating team dynamics in the emergency department. JACEP Open . 2023;4(4):e13024.
    1. Ozkaynak M, Wu DT, Hannah K, Dayan PS, Mistry RD. Examining workflow in a pediatric emergency department to develop a clinical decision support for an antimicrobial stewardship program. Appl Clin Inform . 2018;9(02):248–260.

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