Inter‐rater Agreement for Movement Disorder Classification in Children with Hyperkinetic Movement Disorders

ABSTRACT Background Accurate classification is essential for addressing childhood movement disorders (MD), but the common coexistence of multiple MDs complicates this process. Objective The aim was to assess inter‐rater agreement on classifying hyperkinetic MDs among pediatric neurologists with expertise in MDs. Methods Five pediatric neurologists were requested to examine 112 videos of 66 pediatric patients. Based on the Movement Disorder‐Childhood Rating Scale, 3 queries were posed: (Q1) Is there more than 1 MD? (Q2) What is the (predominant) MD? (Q3) What is the other MD (if present)? Results The final agreement rates were 57.5% for Q1, 66.6% for Q2, and 43.9% for absolute agreement. All videos with absolute agreement at the first evaluation featured 1 MD, whereas only 2 videos with multiple MDs could totally agree in the final review. Conclusions This study reveals significant discordance in classification even among pediatric neurologists with expertise in MDs and highlights the necessity for a standardized approach.