INTERRATER RELIABILITY OF CERVICAL-SPINE INJURY CRITERIA IN PATIENTS WITH BLUNT TRAUMA

Study objective: To determine the interrater reliability of previously defined risk criteria for cervical spine injury. Methods: Two emergen cy physicians independently evaluated patients with blunt trauma to de termine whether they exhibited any of four risk criteria: (1) altered neurologic function; (2) evidence of intoxication; (3) spinous process or posterior midline cervical tenderness; or (4) distracting painful injury. Each criterion was explicitiy described on study data forms. P hysician concordance was measured, and the kappa statistic was calcula ted, for the combined risk criteria (based on the presence of any indi vidual criterion), and for each individual criterion. Results: There w ere 122 patients evaluated. Physicians agreed on overall classificatio ns for 107 patients (87.7%; kappa, .73; confidence interval [CI], .61 to .86). Agreement for individual criteria were as follows. (1) altere d neurologic function-102 patients (83.6%; kappa, .58; CI, .41 to .74) ; (2) intoxication-118 patients (96.7%; kappa, .86; CI, .72 to .99); ( 3) posterior midline tenderness-109 patients (89.3%; kappa, .77; CI, . 65 to .89); (4) distracting injury-112 patients (91.8%; kappa, .77; CI , .64 to .91). Conclusion: The combined cervical spine injury criteria have substantial interrater reliability Individual criteria are sligh tly less reliable.