Biomaterial Database

Inter-rater agreement of paramedic rhythm labeling. 1993

R G Pirrallo, and R A Swor, and R F Maio

Department of Emergency Medicine, William Beaumont Hospital, Royal Oak, Michigan.

OBJECTIVE Substantial inter-rater agreement is present in the labeling by paramedics of ventricular fibrillation and asystolic rhythms. METHODS Prospective, cross-sectional study. METHODS One hundred five practicing paramedics from nonvolunteer agencies who are advanced cardiac life support certified. METHODS Five static cardiac arrest rhythm strips, classified by Cummins' average peak amplitude method, were arranged into five different orders of presentation and placed into five booklets. The paramedics were instructed to label each rhythm ventricular fibrillation or asystole based on rhythm recognition, not on treatment plan. RESULTS The overall kappa value for labeling the five rhythms was .63, indicating a moderate degree of inter-rater agreement. However, as the rhythm's amplitude decreased, the amount of inter-rater agreement also decreased. When the amplitude was approximately 1 mm, agreement was no different than chance; the proportion of paramedics labeling the rhythm ventricular fibrillation was .46 (95% confidence interval, .36, .56). Only a flat line (0 mm) demonstrated perfect inter-rater agreement, with no paramedic labeling the rhythm ventricular fibrillation. CONCLUSIONS Inter-rater agreement of ventricular fibrillation rhythm labeling by paramedics in this emergency medical services system was amplitude dependent. An analysis of ventricular fibrillation rhythm data that does not address the degree of inter-rater agreement of rhythm labeling cannot ensure uniform reporting of out-of-hospital cardiac arrest data.

UI	MeSH Term	Description	Entries
D008499	Medical Records	Recording of pertinent information concerning patient's illness or illnesses.	Health Diaries,Medical Transcription,Records, Medical,Transcription, Medical,Diaries, Health,Diary, Health,Health Diary,Medical Record,Medical Transcriptions,Record, Medical,Transcriptions, Medical
D011446	Prospective Studies	Observation of a population for a sufficient number of persons over a sufficient number of years to generate incidence or mortality rates subsequent to the selection of the study group.	Prospective Study,Studies, Prospective,Study, Prospective
D003430	Cross-Sectional Studies	Studies in which the presence or absence of disease or other health-related variables are determined in each member of the study population or in a representative sample at one particular time. This contrasts with LONGITUDINAL STUDIES which are followed over a period of time.	Disease Frequency Surveys,Prevalence Studies,Analysis, Cross-Sectional,Cross Sectional Analysis,Cross-Sectional Survey,Surveys, Disease Frequency,Analyses, Cross Sectional,Analyses, Cross-Sectional,Analysis, Cross Sectional,Cross Sectional Analyses,Cross Sectional Studies,Cross Sectional Survey,Cross-Sectional Analyses,Cross-Sectional Analysis,Cross-Sectional Study,Cross-Sectional Surveys,Disease Frequency Survey,Prevalence Study,Studies, Cross-Sectional,Studies, Prevalence,Study, Cross-Sectional,Study, Prevalence,Survey, Cross-Sectional,Survey, Disease Frequency,Surveys, Cross-Sectional
D004562	Electrocardiography	Recording of the moment-to-moment electromotive forces of the HEART as projected onto various sites on the body's surface, delineated as a scalar function of time. The recording is monitored by a tracing on slow moving chart paper or by observing it on a cardioscope, which is a CATHODE RAY TUBE DISPLAY.	12-Lead ECG,12-Lead EKG,12-Lead Electrocardiography,Cardiography,ECG,EKG,Electrocardiogram,Electrocardiograph,12 Lead ECG,12 Lead EKG,12 Lead Electrocardiography,12-Lead ECGs,12-Lead EKGs,12-Lead Electrocardiographies,Cardiographies,ECG, 12-Lead,EKG, 12-Lead,Electrocardiograms,Electrocardiographies, 12-Lead,Electrocardiographs,Electrocardiography, 12-Lead
D004634	Emergency Medical Technicians	Allied health personnel trained to provide basic emergency care and life support under the supervision of physicians and/or nurses. These services may be carried out at the site of the emergency, in the ambulance, or in a health care institution.	Advanced EMT,Advanced Emergency Medical Technicians,Emergency Medical Technician,Emergency Medicine Technicians,Medical Technician, Emergency,Medical Technicians, Emergency,Technician, Emergency Medical,Technicians, Emergency Medical,Advanced EMTs,EMT, Advanced,EMTs, Advanced,Emergency Medicine Technician,Technician, Emergency Medicine,Technicians, Emergency Medicine
D006323	Heart Arrest	Cessation of heart beat or MYOCARDIAL CONTRACTION. If it is treated within a few minutes, heart arrest can be reversed in most cases to normal cardiac rhythm and effective circulation.	Asystole,Cardiac Arrest,Cardiopulmonary Arrest,Arrest, Cardiac,Arrest, Cardiopulmonary,Arrest, Heart,Asystoles
D006801	Humans	Members of the species Homo sapiens.	Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D014693	Ventricular Fibrillation	A potentially lethal cardiac arrhythmia that is characterized by uncoordinated extremely rapid firing of electrical impulses (400-600/min) in HEART VENTRICLES. Such asynchronous ventricular quivering or fibrillation prevents any effective cardiac output and results in unconsciousness (SYNCOPE). It is one of the major electrocardiographic patterns seen with CARDIAC ARREST.	Fibrillation, Ventricular,Fibrillations, Ventricular,Ventricular Fibrillations
D015588	Observer Variation	The failure by the observer to measure or identify a phenomenon accurately, which results in an error. Sources for this may be due to the observer's missing an abnormality, or to faulty technique resulting in incorrect test measurement, or to misinterpretation of the data. Two varieties are inter-observer variation (the amount observers vary from one another when reporting on the same material) and intra-observer variation (the amount one observer varies between observations when reporting more than once on the same material).	Bias, Observer,Interobserver Variation,Intraobserver Variation,Observer Bias,Inter-Observer Variability,Inter-Observer Variation,Interobserver Variability,Intra-Observer Variability,Intra-Observer Variation,Intraobserver Variability,Inter Observer Variability,Inter Observer Variation,Inter-Observer Variabilities,Inter-Observer Variations,Interobserver Variabilities,Interobserver Variations,Intra Observer Variability,Intra Observer Variation,Intra-Observer Variabilities,Intra-Observer Variations,Intraobserver Variabilities,Intraobserver Variations,Observer Variations,Variabilities, Inter-Observer,Variabilities, Interobserver,Variabilities, Intra-Observer,Variabilities, Intraobserver,Variability, Inter-Observer,Variability, Interobserver,Variability, Intra-Observer,Variability, Intraobserver,Variation, Inter-Observer,Variation, Interobserver,Variation, Intra-Observer,Variation, Intraobserver,Variation, Observer,Variations, Inter-Observer,Variations, Interobserver,Variations, Intra-Observer,Variations, Intraobserver,Variations, Observer