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oai:figshare.com:article/34023818 2026-10-06T17:58:48Z category_4 category_7 category_13 category_14 category_15 category_19 category_21 category_46 category_106 category_122 category_128 category_132 portal_87 item_type_6 month_year_10_2026

Interobserver Agreement in Pediatric Asthma Examination Findings Between Emergency Medical Services and Emergency Department Clinicians Michael F. Taylor (25372029) Caleb E. Ward (6504518) Jennifer F. Anders (8261550) Adjoa A. Andoh (22918952) James M. Chamberlain (5822240) Nidhya Navanandan (8296305) Sylvia Owusu-Ansah (6559829) Kyle Schmucker (25137101) Bobbe Thomas (25137104) Kathleen M. Brown (5426165) Biochemistry Medicine Genetics Molecular Biology Neuroscience Pharmacology Biotechnology Immunology Science Policy Mental Health Hematology Infectious Diseases intraclass correlation coefficient five pediatric eds elevated respiratory rate calculated using kappa accessory muscle use asthma scoring tools emergency medical services prospective observational study 21 – 0 01 – 0 asthma severity scores observed limited agreement 0 – 0 respectively .</ p emergency department clinicians emergency department asthma exacerbation study sought exacerbation severity survey items suprasternal retractions rater reliability poor agreement patient ’ ordinal variables median age interobserver agreement focus groups fair agreement expert stakeholders determine agreement delphi process convenience sample clinical outcomes assessing children 7 years 295 children Asthma exacerbations constitute 10-15% of all pediatric emergency medical services (EMS) calls. There are several validated scoring tools to assess acute asthma severity, which have good inter-rater reliability and correlate with clinical outcomes in the emergency department (ED), but have not been validated with EMS clinicians. This study sought to assess the level of agreement between EMS and ED clinicians on components of asthma scoring tools to inform a prehospital asthma severity scoring tool. We conducted a prospective observational study of children 2–18 years old transported by EMS with an impression of asthma exacerbation to five pediatric EDs. EMS and ED clinicians independently completed surveys assessing the patient’s exam on arrival to the ED. Survey items were drawn from existing asthma scoring tools and refined by focus groups and a Delphi process with EMS clinicians and expert stakeholders. To determine agreement between EMS and ED clinicians regarding survey items, inter-rater reliability was calculated using Kappa and intraclass correlation coefficient for binary and ordinal variables, respectively. We enrolled a convenience sample of 295 children with a median age of 7 years (inter-quartile range 3–12 years). There was slight agreement among EMS and ED clinicians (κ = 0.01–0.20) for suprasternal retractions and fair agreement (κ = 0.21–0.40) for tachypnea, accessory muscle use, and elevated respiratory rate. There was poor agreement (ICC = 0–0.50) for breathlessness, work of breathing, degree of hypoxia, type of wheeze, and wheezing intensity. We observed limited agreement between EMS and ED clinicians when assessing children for components of asthma severity scores. Developing a prehospital asthma exacerbation severity scoring tool to guide EMS interventions may be challenging. Further research is needed to determine whether education improves EMS performance with asthma scoring tools or whether standardized EMS asthma protocols, regardless of exacerbation severity, improve patient outcomes. 2026-10-06T17:58:48Z Text Journal contribution 10.6084/m9.figshare.34023818.v2 https://figshare.com/articles/journal_contribution/Interobserver_Agreement_in_Pediatric_Asthma_Examination_Findings_Between_Emergency_Medical_Services_and_Emergency_Department_Clinicians/34023818 CC BY 4.0