• Joan Elizabeth Giovanni, Mary Denise Dowd, Chris Kennedy, and Jeffrey G Michael.
• Division of Emergency Medical Services, The Children's Mercy Hospitals and Clinics, Kansas City, MO 64108, USA. gegiovanni@cmh.edu
• Pediatr Emerg Care. 2011 Jun 1;27(6):475-8.

ObjectiveThis study aimed to measure interexaminer agreement for physical examination (PE) findings in children with a suspected soft tissue abscess.MethodsA prospective study was conducted from March 1 to July 31, 2007, at an urban, tertiary care children's hospital emergency department. Children presenting to the emergency department with a suspected local skin abscess were independently examined by 2 physicians. Interrater agreement of 7 PE findings for children with a suspected soft tissue abscess was assessed. Interrater agreement was calculated for the diagnosis of the lesion and decision to incise and drain.ResultsA total of 105 paired observations were completed by a total of 27 physicians. The patients examined were aged 2 weeks to 18 years, with a mean age of 80 months. Lesions were most frequently encountered on the buttocks (38%). Incision and drainage was attempted in 75% of cases, with purulent material obtained in 92% of all attempts. Interrater agreement was substantial for erythema (κ = 0.66) and size of the lesion (intraclass correlation coefficient = 0.78), moderate for drainage (κ = 0.57) and tenderness (κ = 0.40), fair for fluctuance (κ = 0.35), and poor for warmth (κ = 0.15) and showed no agreement for induration (κ = -0.08). There was moderate agreement on diagnosing the lesion as an abscess (κ = 0.48) and determination if the lesion required incision and drainage (κ = 0.44).ConclusionsInterexaminer agreement of examination findings and diagnosis of an abscess was fair to moderate, implying a lack of precision of PE as the primary means for diagnosis. Future studies of diagnostic adjuncts, such as bedside ultrasonography, may lead to improved management of soft tissue infections in children.

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