Global assessment of patients--a bedside study. II. Inter-observer variation and frequency of clinical findings.

Abstract

Three physicians independently assessed 201 hospital in-patients for the presence of 10 basic physical characteristics, and made an overall assessment of whether or not the patients appeared ill. There were significant differences between the physicians in the average number of observations recorded for each patient (P less than 0.001). There was a significant difference (P less than 0.05) between the physicians regarding the number of positive diagnoses of anaemia, abnormal nutritional state, breathing difficulties and the overall assessment. Inter-observer variation was estimated by a pairwise comparison of the three physicians. Overall agreement rates ranged from 0.65 for abnormal nutritional state to 0.99 for presence of pain. After adjusting for random agreement, kappa values between 0.09 (elevated body temperature) and 0.88 (consciousness impaired) were found. No tendency towards a higher level of agreement in the overall assessment than in the basic findings was observed.