INTEROBSERVER AGREEMENT OF THE ASSESSMENT OF COMA SCALES AND BRAIN-STEM SIGNS IN NONTRAUMATIC COMA

The authors evaluated the inter-observer agreement between two experie nced clinicians examining 19 unconscious children who were not paralys ed or ventilated. Inter-observer reliability was assessed by proportio n of agreement, disagreement rate and kappa statistics. Corneal reflex es, pupillary responses to light and motor responses were the most rel iably elicited, Reduction of the number of categories improved inter-o bserver agreement. Some of the disagreement may be attributed to chang es in the child's condition during the period of assessment. There was more agreement about the five-category 0-IV scale than the summated A delaide (10-category) and Jacobi (13-category) scales. The ability of these scales to follow changes in the patients condition and to predic t outcome needs to be evaluated in a prospective trial.