Limited Reliability of Physical Examination in Pneumonia

Investigators from the Cincinnati Children’s Hospital Medical Center and the University of Cincinnati conducted a prospective study to determine the rate of agreement between 2 examiners, or interrater reliability (IRR), for specific physical examination findings in children with possible community-acquired pneumonia (CAP). Study participants were children 3 months to 18 years old who were seen at a pediatric ED for signs and symptoms of lower respiratory tract infection and who underwent chest radiography. For enrolled participants, 2 clinicians (including pediatric emergency medicine attending physicians and fellows or nurse practitioners) independently conducted a physical examination and recorded their findings on a standardized form. Examination findings included general appearance, behavior (eg, lethargic, playing, or appropriate behavior), skin color, perfusion (eg, capillary refill time), presence of abdominal pain or tenderness, overall impression, and multiple respiratory findings …