PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 1617865

Interobserver variability in assessing pediatric postextubation stridor.

K J Kemper·M S Benson·M J Bishop
View original source ↗Export metadata ↓

Abstract

The reliability of parameters used to assess pediatric postextubation upper respiratory distress is unknown. We prospectively studied the interobserver reliability of six parameters commonly used to assess respiratory distress in children. Eligible patients were less than 15 years old and hospitalized for traumatic injuries at Harborview Medical Center between March and September 1989. At extubation, patients were examined independently by a physician, a nurse, and a respiratory therapist, each of whom evaluated respiratory rate (RR), stridor, air movement, flaring/retractions (F/R), level of consciousness (LOC), and oxygen saturation (O2 sat). Reliability was measured by percentage agreement and weighted kappa (Kw). The 25 children (27 extubations) had a median age of 7 years, and eight of the 27 required treatment for upper airway obstruction. Percentage agreement ranged from 82% (for air movement) to 96% (for O2 sat). Weighted kappas were excellent for RR and F/R (Kw greater than .6); moderate for LOC, stridor, and O2 sat (0.4 less than Kw less than .06); and poor for air movement (Kw less than .4). Further improvements in interobserver agreement are required to provide more consistent upper airway management in critically ill children.

Explore related subjects

Academic Medical CentersAdolescentChildChild, PreschoolConsciousnessEvaluation Studies as TopicHumansInfantIntensive Care UnitsMedical Staff, HospitalNursing Staff, HospitalObserver VariationOximetryProspective StudiesRespirationRespiratory InsufficiencyRespiratory MusclesRespiratory TherapySeverity of Illness IndexVentilator WeaningWashingtonJournal ArticleResearch Support, Non-U.S. Gov't

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

K J Kemper, M S Benson, M J Bishop. 1992. Interobserver variability in assessing pediatric postextubation stridor.. https://doi.org/10.1177/000992289203100705

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed1993

Academic careers: choice and activity of graduates of a pediatric residency program 1974-1986.

In summary, our data suggest that the playing field for academic medicine is changing. It is more patient care oriented, more multifaceted and supported more by clinical dollars than in the past. Greater flexibility in what constitutes "academic success" is necessary to assure a supportive environment in which tomorrow's academic faculty can develop and flourish. To accomplish these goals promotion systems that reward not only research but also teaching and clinical care accomplishments will be necessary. Clinicians will need to be compared with clinicians, teachers with teachers, clinical investigators with clinical investigators and basic investigators with basic investigators. Sources of support will need to be more clearly targeted along activity lines with clinical dollars supporting the clinician, medical education dollars supporting the teacher-educators and federal and foundation dollars supporting research. In our department, time and effort for research (45%) approximates dollar support for this activity (44%), while clinical dollars (43%) fund to a greater degree time and effort committed to clinical care (34%), and administration and teaching dollars (13%) under fund time and effort committed to these activities (21%). This suggests the need to identify increased funding to support teaching and education. Promotion expectations for women will need to be more flexible and adjusted to family responsibilities and demands. Most of all, however, we academic faculty must support enthusiastically the importance and joy of our work. We must be encouraging to our colleagues and our students and continue to recognize that for all of the difficulties and challenges, academic life is a rewarding and fulfilling enterprise.

Academic Medical Centers↗
PubMed1992

Medical Information Service via Telephone. The pioneer of physician consultation services.

The organization and development of MIST were a response to the needs of health professionals in Alabama, principally rural physicians, who expressed a desire to access the knowledge of the faculty at the UAB Medical Center. MIST provides free service on a 24-hour, 7-day-a-week basis for physicians around the world. At any time, practitioners can obtain specific medical information and discuss possible diagnoses or patient-related problems with UAB specialists. MIST, the first and largest medical professional telephone consultation program of its kind, receives numerous requests from other institutions seeking information and advice on developing similar programs. Such programs now exist in many states. One reason for the success of MIST is that it has always enjoyed high visibility with UAB physicians, credibility with the physician callers, and priority within UAB's Office of the Vice President for Health Affairs. As a consultative system, MIST continues to contribute to improved health care for citizens of Alabama and beyond and to save patients and taxpayers the expense of unnecessary or inappropriate treatment. MIST provides consultation and continuing education at the moment of need for the professional in private practice. In return, UAB specialists are given access to vital research and demographic information, as well as patient referrals. MIST plays an important role in removing barriers to education and consultation for busy medical personnel and in facilitating patient referrals to an acclaimed center of research and excellent patient care. Rather than searching for the proper contact, one call to an easy-to-remember number puts the health professional in touch with the appropriate source. Rural doctors, as well as medical personnel working in urban areas, can feel that they are practicing "right next door" to an outstanding university medical center where colleagues who are ready and able to offer expert consultation and support at the critical moment of need are only a telephone call away.

Academic Medical Centers↗