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 <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 (02 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 02 sat). Weighted kappas were excellent for RR and F/R (Kw >.6); moderate for LOC, stridor, and 02 sat (0.4 <Kw <.06); and poor for air movement (Kw <.4). Further improvements in interobserver agreement are required to provide more consistent upper airway management in critically ill children.
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