Background
Methods
Database
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Search Terms
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Search terms cont
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Interobserver reliability search | Diagnostic accuracy search | |||||
MEDLINE (OVID) | #S1 | “Emergency medical services” OR EMS.mp. OR prehospital$.mp. OR pre-hospital$.mp. OR “out of hospital”.mp. OR paramedic$.mp. OR ambulance.mp | #S6 | Interobserver.mp OR reliability.mp. OR agreement.mp | #S8 | Accuracy.mp OR over-triage.mp. OR under-triage.mp |
#S2 | “Traumatic brain injury”.mp. or exp brain injuries, traumatic/OR TBI OR “head injury$”.mp. OR Concussion$.mp | #S7 | S5 AND S6 | #S9 | S5 AND S8 | |
#S3 | Paediatric$.mp. OR paediatric$.mp. OR child$.mp. OR kid$.mp. OR adolesce$.mp. OR teenage$.mp | |||||
#S4 | Triage.mp | |||||
#S5 | S1 AND S2 AND S3 AND S4 |
Eligibility criteria and data collection
Quality assessment and risk of bias
Data synthesis
Study selection
Study characteristics
Publication (year) | Study design | Country | Study period | Demographic | Sample size | |
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Interobserver reliability studies | Nesiama et al. (2012) | Medical record review | USA | 2000–2005 | 5–18 years | 185 |
Drews et al. (2019) | Retrospective review | USA | 1994–2016 | < 18 years | 1711 | |
Nuttall et al. (2018) | Cross-sectional study | UK | September 2009–February 2010 | < 15 years | 911 | |
Diagnostic accuracy studies | Lyttle et al. (2013) | Retrospective clinical registry data | UK | 2007–2012 | < 16 years | 334 |
Cabrero Hernández et al. (2022) | Observational cohort study; data collected prospectively and retrospectively | Spain | 2002–2017 | Not specified | 98 |
Risk of bias assessment
Reliability measure | COSMIN score | |||||
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Cohen’s kappa | Intraclass correlation coefficient | Concordance correlation | Pearson correlation coefficient | Spearman’s correlation | ||
Nesiama et al. (2012) | √ | - | √ | √ | - | Adequate |
Drews et al. (2019) | √ | - | - | - | - | Inadequate |
Nuttall et al. (2018) | √ | - | - | - | - | Inadequate |
Results of individual studies
Interobserver reliability studies | Triage tool | Reference standard | GCS cutoff | Sample size | Both positive | ED negative | Scene negative | Both negative | Cohen’s kappa | SE of kappa | 95% CI | Level of agreement | Pearson correlation coefficient | Concordance correlation | |
Nesiama et al. (2012) | GCS | - | - | 185 | - | - | - | - | 0.69 | - | 0.57–0.81 | Good | 0.841 | 0.839 | |
Drews et al. (2019) | GCS | ICD-9 | 15 | Age > 3 | 399 | 127 | 232 | 690 | 0.486 | 0.023 | 0.441–0.531 | Moderate | - | - | |
1448 | |||||||||||||||
Age < 3 | 76 | 29 | 57 | 101 | 0.348 | 0.056 | 0.237–0.458 | Fair | - | - | |||||
263 | |||||||||||||||
Nuttall et al. (2018) | GCS | - | 15 | 911 | 190 | 73 | 78 | 570 | 0.599 | 0.029 | 0.541–0.656 | Moderate | - | - | |
Diagnostic accuracy studies | Triage tool | Reference standard | Overtriage rate | Undertriage rate | Predictive values | Sensitivity | Specificity | 95% CI | |||||||
TP | FN | FP | TN | PPV% | NPV% | ||||||||||
Lyttle et al. (2013) | PTS | AIS ≥ 3 | 10% | 62% | - | - | - | - | - | - | - | - | - | ||
Trauma tape | 18% | 68% | - | - | - | - | - | - | - | - | - | ||||
Cabrero Hernández et al. (2022) | GCS | ICD-9 | - | - | 19 | 3 | 22 | 54 | 46.34% | 95% | 86.67% | 71.43% | 0.74–0.96 |