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Abstract
Objective
The physical examination of the abdomen is crucial to emergency department (ED) management of patients with abdominal pain. We sought to determine the interrater variation between attending and resident physicians in detecting abdominal exam findings.
Methods
Research enrollers surveyed attending and resident physicians on abdominal exam findings in the ED in patients with abdominal pain. Strength of agreement was calculated using the κ statistic.
Results
A convenience sample of 122 surveys was completed. Calculated κ results are in parentheses. There was almost perfect agreement on the presence of masses and substantial agreement on the need for imaging studies. There was moderate agreement on guarding, distension, tenderness, and need for laboratory tests and surgical consultation. For 88 (72%) patients with tenderness, substantial agreement was calculated for epigastric tenderness, moderate agreement on right upper quadrant, supraumbilical, suprapubic, left lower quadrant, right lower quadrant tenderness, and fair agreement on left upper quadrant tenderness. Sixty-one (50%) patients received pain medicine in the ED. Among those, there was fair agreement on a presence of a surgical abdomen. Upper level resident physicians noted a higher level of agreement with the attending physician for tenderness than junior resident physicians.
Conclusions
There was moderate agreement between resident and attending physicians for most of the findings in patients with abdominal pain. Recognition that selected findings are more variable than others should encourage careful confirmation of resident physicians' assessments in teaching settings.
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✯This work was presented at the Plenary Session of the SAEM mid-Atlantic meeting in Washington, DC, in March 2003 and also as an oral presentation for the SAEM national assembly in Boston in May 2003.
✯✯Dr Pines developed and conceived the idea for this study, prepared and submitted the IRL proposal, and prepared the first draft and implanted the revisions into the manuscript. Ms Uscher was involved in the extensive manuscript editing, and was involved in helping Dr Pines develop the study idea. Mr Hall and Mr Hunter attended development meetings for this project and were in charge of data entry and initial data analysis. Dr Srinivasan attended development meetings and performed the statistical analysis for this project. Dr Ghaemmaghami was involved with the conception and development, and helped edit the manuscript. He oversaw the project.
