The National Emergency X-Radiography Utilization Study (NEXUS) developed a decision rule for when cervical spine radiographs are required in the setting of trauma. To our knowledge, inter-rater reliability between resident and faculty emergency physicians has not been studied.
This study seeks to compare the inter-rater agreement of postgraduate year (PGY) 2–4 emergency medicine (EM) residents vs. EM faculty physicians.
A convenience sample of patients presenting to an urban, academic, Level II emergency department (ED) with complaints of cervical spine pain after trauma were enrolled. All subjects received separate examinations by an EM faculty physician and by a PGY 2–4 EM resident in a blinded fashion. Eighty subjects were enrolled in the study.
Agreement for each of the NEXUS components were: posterior midline tenderness (PMT) 85.0% and κ = 0.70, intoxication (TOX) 95.0% and κ = 0.72, altered mental status (AMS) 87.5% and κ = 0.22, focal neurologic deficit (FND) 92.5% and κ = 0.21, and presence of a distracting injury (DIS) 88.8% and κ = 0.13. Overall agreement for need for radiographs was 77.5% and κ = 0.53. Sixty of the subjects received radiography (28 computed tomography, 40 plain films, 8 both). One fracture (C1 lamina) was detected in this dataset. Two of the five NEXUS criteria (PMT, TOX) demonstrated substantial agreement, two (AMS, FND) fair agreement, and one (DIS) slight agreement.
Based on our findings, there was considerable difference in agreement between staff physicians and residents. This could be due to the level of experience of the provider or the subjectiveness of components the criteria.
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Published online: January 21, 2015
Accepted: November 16, 2014
Received in revised form: October 27, 2014
Received: May 18, 2014
The views expressed in this article are those of the authors and do not necessarily reflect the official policy or position of the Department of the Navy, Department of Defense, nor the US Government.
Published by Elsevier Inc.