Skip to main content

Advertisement

SpringerLink
Log in

Interobserver agreement on signs and symptoms of patients with acute febrile illness

  • Clinical and Epidemiological Study
  • Published:
Infection Aims and scope Submit manuscript

Abstract

Purpose

To assess the interobserver agreement on clinical history and physical examination when using a semi-structured questionnaire to evaluate patients with an acute febrile illness (AFI).

Methods

A cross-sectional study was conducted with outpatients aged 12 years and over, presenting with an AFI defined as fever up to 7 days and no evident focus of infection. Clinical data were collected independently by two physicians using a semi-structured questionnaire. Interobserver agreement was estimated using kappa coefficients with a 95% confidence interval (CI).

Results

A total of 140 patients (age range 13–73 years; 56.4% females) were enrolled. All symptoms showed weighted kappa values significantly greater than 0.6, indicating an at least substantial agreement. As most physical signs were infrequent and of mild intensity, they were recoded and analyzed as absent/present. Of the signs with prevalence ≥15%, exanthema, pallor, lymph node enlargement, and eye congestion showed agreements significantly greater than 0.6, while kappa confidence limits for pharyngeal erythema and dehydration included values classified as regular.

Conclusions

High agreement was observed for most of the clinical data assessed, and symptom grading was feasible. Some physical findings were rare and their inclusion in a structured form may not be justified in this setting. The questionnaire application showed good reliability for the most frequent signs and symptoms and may prove to be useful at gathering data for surveillance and research at sentinel sites.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Dassanayake DL, Wimalaratna H, Agampodi SB, Liyanapathirana VC, Piyarathna TA, Goonapienuwala BL. Evaluation of surveillance case definition in the diagnosis of leptospirosis, using the microscopic agglutination test: a validation study. BMC Infect Dis. 2009;9:48.

    Article  PubMed  Google Scholar 

  2. Crump JA, Youssef FG, Luby SP, Wasfy MO, Rangel JM, Taalat M, et al. Estimating the incidence of typhoid fever and other febrile illnesses in developing countries. Emerg Infect Dis. 2003;9:539–44.

    PubMed  Google Scholar 

  3. Gubler DJ. Surveillance for dengue and dengue hemorrhagic fever. Bull Pan Am Health Organ. 1989;23:397–404.

    PubMed  CAS  Google Scholar 

  4. Marzochi KBF. Endemic dengue: surveillance strategy challenges. Rev Soc Bras Med Trop. 2004;37:413–5. doi:10.1590/S0037-86822004000500009.

    PubMed  Google Scholar 

  5. Archibald LK, Reller LB. Clinical microbiology in developing countries. Emerg Infect Dis. 2001;7:302–5.

    Article  PubMed  CAS  Google Scholar 

  6. Peat G, Wood L, Wilkie R, Thomas E. How reliable is structured clinical history-taking in older adults with knee problems? Inter- and intraobserver variability of the KNE-SCI. J Clin Epidemiol. 2003;56:1030–7. doi:10.1016/S0895-4356(03)00204-X.

    Article  PubMed  Google Scholar 

  7. Manterola C, Muñoz S, Grande L, Bustos L. Initial validation of a questionnaire for detecting gastroesophageal reflux disease in epidemiological settings. J Clin Epidemiol. 2002;55:1041–5. doi:10.1016/S0895-4356(02)00454-7.

    Article  PubMed  Google Scholar 

  8. Bossuyt PM, Reitsma JB, Bruns DE, Gatsonis CA, Glasziou PP, Irwig LM, et al. Towards complete and accurate reporting of studies of diagnostic accuracy: the STARD initiative. Fam Pract. 2004;21:4–10.

    Article  PubMed  Google Scholar 

  9. Margolis P, Gadomski A. The rational clinical examination. Does this infant have pneumonia? JAMA. 1998;279:308–13. doi:10.1001/jama.279.4.308.

    Article  PubMed  CAS  Google Scholar 

  10. Streiner DL, Norman GR. Health measurement scales: a practical guide to their development and use. 2nd ed. Oxford: Oxford University Press; 1995.

    Google Scholar 

  11. Porto CC. Semiologia médica. 5th ed. Rio de Janeiro: Guanabara Koogan; 2005.

    Google Scholar 

  12. Schechter M, Marangoni DV. Doenças infecciosas: conduta diagnóstica e terapêutica. 2nd ed. Rio de Janeiro: Guanabara Koogan; 1998.

    Google Scholar 

  13. Kasper DL, Braunwald E, Hauser S, Longo DL, Jameson JL, Fauci AS. Harrison’s principles of internal medicine. 16th ed. New York: McGraw-Hill Medical Publishing Division; 2005.

    Google Scholar 

  14. Lauritsen JM, Bruus M. EpiData (version 3). A comprehensive tool for validated entry and documentation of data. Odense, Denmark: The EpiData Association; 2003–2004.

  15. StataCorp. Stata Statistical Software: Release 9. College Station, TX: StataCorp LP; 2005.

  16. Cohen J. A coefficient of agreement for nominal scales. Educ Psychol Meas. 1960;20:37–46.

    Article  Google Scholar 

  17. Fleiss JL. Statistical methods for rates and proportions. 2nd ed. New York: Wiley; 1981.

    Google Scholar 

  18. Reichenheim ME. Confidence intervals for the kappa statistic. Stata J. 2004;4:421–8.

    Google Scholar 

  19. Landis JR, Koch GG. The measurement of observer agreement for categorical data. Biometrics. 1977;33:159–74.

    Article  PubMed  CAS  Google Scholar 

  20. Cicchetti DV, Feinstein AR. High agreement but low kappa: II. Resolving the paradoxes. J Clin Epidemiol. 1990;43:551–8. doi:10.1016/0895-4356(90)90159-M.

    Article  PubMed  CAS  Google Scholar 

  21. Passos SR, Bedoya SJ, Hökerberg YH, Maia SC, Georg I, Nogueira RM, et al. Clinical and laboratory signs as dengue markers during an outbreak in Rio de Janeiro. Infection. 2008;36:570–4. doi:10.1007/s15010-008-7334-6.

    Article  PubMed  CAS  Google Scholar 

  22. Schwartz K, Monsur J, Northrup J, West P, Neale AV. Pharyngitis clinical prediction rules: effect of interobserver agreement: a MetroNet study. J Clin Epidemiol. 2004;57:142–6. doi:10.1016/S0895-4356(03)00249-X.

    Article  PubMed  Google Scholar 

  23. Takemura Y, Atsumi R, Tsuda T. Identifying medical interview behaviors that best elicit information from patients in clinical practice. Tohoku J Exp Med. 2007;213:121–7. doi:10.1620/tjem.213.121.

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

We are grateful to: Liliane Alves Reis and Marlene da Conceição Rezende for the administrative support; Patrícia Rosana de Souza for contribution to the data collection; João Claudio Arnaldo Alves e Flávia Lattario Ribeiro for help with the data entry; emergency medical staff, laboratory personnel, epidemiology service team, and the director of the Lourenço Jorge Municipal Hospital for all of the support provided. This work was supported by grants from the Fundação Oswaldo Cruz, Programa de Desenvolvimento e Inovação Tecnológica em Saúde Pública (PDTSP-Dengue—RDCL 05 Project) and Conselho Nacional de Desenvolvimento Científico e Tecnológico, CNPq (MS-SCTIE-DECIT 25/2006).

Conflict of interest

The authors declare that they have no conflict of interest.

Author information

Authors and Affiliations

  1. Laboratory of Clinical Epidemiology, Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Av Brasil, 4365—Manguinhos, Rio de Janeiro, RJ, Brazil

    R. P. Daumas, R. V. C. Oliveira, B. B. G. Carvalho, D. V. Carneiro & S. R. L. Passos

  2. Laboratory of Acute Febrile Diseases, Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation, Av Brasil, 4365—Manguinhos, Rio de Janeiro, RJ, Brazil

    P. Brasil & C. S. Bressan

Authors
  1. R. P. Daumas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. P. Brasil
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. S. Bressan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. R. V. C. Oliveira
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. B. B. G. Carvalho
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. D. V. Carneiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. R. L. Passos
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to R. P. Daumas.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 125 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Daumas, R.P., Brasil, P., Bressan, C.S. et al. Interobserver agreement on signs and symptoms of patients with acute febrile illness. Infection 39, 135–140 (2011). https://doi.org/10.1007/s15010-011-0101-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s15010-011-0101-0

Keywords

Search

Navigation