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 emergency physicians independently evaluated patients with blunt trauma to determine 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 explicitly described on study data forms. Physician concordance was measured, and the κ statistic was calculated, for the combined risk criteria (based on the presence of any individual criterion), and for each individual criterion. Results: There were 122 patients evaluated. Physicians agreed on overall classifications for 107 patients (87.7%; κ, .73; confidence interval [CI], .61 to .86). Agreement for individual criteria were as follows: (1) altered neurologic function–102 patients (83.6%; κ, .58; CI, .41 to .74); (2) intoxication–118 patients (96.7%; κ, .86; CI, .72 to .99); (3) posterior midline tenderness–109 patients (89.3%; κ, .77; CI, .65 to .89); (4) distracting injury–112 patients (91.8%; κ, .77; CI, .64 to .91). Conclusion: The combined cervical spine injury criteria have substantial interrater reliability. Individual criteria are slightly less reliable. [Mahadevan S, Mower WR, Hoffman JR, Peeples N, Goldberg W, Sonner R: Interrater reliability of cervical spine injury criteria in patients with blunt trauma. Ann Emerg Med February 1998;31:197-201.]