• S Mahadevan, W R Mower, J R Hoffman, N Peeples, W Goldberg, and R Sonner.
• UCLA Emergency Medicine Center, USA.
• Ann Emerg Med. 1998 Feb 1;31(2):197-201.

Study ObjectiveTo determine the interrater reliability of previously defined risk criteria for cervical spine injury.MethodsTwo 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 kappa statistic was calculated, for the combined risk criteria (based on the presence of any individual criterion), and for each individual criterion.ResultsThere were 122 patients evaluated. Physicians agreed on overall classifications for 107 patients (87.7%; kappa, .73; confidence interval [CI], .61 to .86). Agreement for individual criteria were as follows: (1) altered neurologic function--102 patients (83.6%; kappa, .58; CI, .41 to .74); (2) intoxication--118 patients (96.7%; kappa, .86; CI, .72 to .99); (3) posterior midline tenderness--109 patients (89.3%; kappa, .77; CI .65 to .89); (4) distracting injury--112 patients (91.8%; kappa.77; CI, .64 to .91).ConclusionThe combined cervical spine injury criteria have substantial interrater reliability. Individual criteria are slightly less reliable.

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