The assessment of bulging fontanel and splitting of sutures in premature infants: an interrater reliability study by the Hydrocephalus Clinical Research Network

Clinical article

John C. Wellons IIISection of Pediatric Neurosurgery, University of Alabama, Birmingham, Alabama;

Search for other papers by John C. Wellons III in
jns
Google Scholar
PubMed
Close
 M.D., M.S.P.H.
,
Richard HolubkovDivision of Critical Care, Department of Pediatrics, University of Utah;

Search for other papers by Richard Holubkov in
jns
Google Scholar
PubMed
Close
 Ph.D.
,
Samuel R. BrowdDivision of Pediatric Neurological Surgery, Seattle Children's Hospital, University of Washington, Seattle, Washington;

Search for other papers by Samuel R. Browd in
jns
Google Scholar
PubMed
Close
 M.D., Ph.D.
,
Jay Riva-CambrinDepartment of Neurosurgery, Division of Pediatric Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah;

Search for other papers by Jay Riva-Cambrin in
jns
Google Scholar
PubMed
Close
 M.D., M.Sc.
,
William WhiteheadPediatric Neurosurgery, Texas Children's Hospital, Department of Neurosurgery, Baylor College of Medicine, Houston, Texas; and

Search for other papers by William Whitehead in
jns
Google Scholar
PubMed
Close
 M.D., M.P.H.
,
John KestleDepartment of Neurosurgery, Division of Pediatric Neurosurgery, Primary Children's Hospital, University of Utah, Salt Lake City, Utah;

Search for other papers by John Kestle in
jns
Google Scholar
PubMed
Close
 M.D.
,
Abhaya V. KulkarniDivision of Neurosurgery, Hospital for Sick Children, Toronto, Ontario, Canada

Search for other papers by Abhaya V. Kulkarni in
jns
Google Scholar
PubMed
Close
 M.D., Ph.D.
, and
for the Hydrocephalus Clinical Research Network
Search for other papers by for the Hydrocephalus Clinical Research Network in
jns
Google Scholar
PubMed
Close
Restricted access

Purchase Now

USD  $45.00

JNS + Pediatrics - 1 year subscription bundle (Individuals Only)

USD  $525.00

JNS + Pediatrics + Spine - 1 year subscription bundle (Individuals Only)

USD  $624.00
USD  $45.00
USD  $525.00
USD  $624.00
Print or Print + Online Sign in

Object

Previous studies from the Hydrocephalus Clinical Research Network (HCRN) have shown a great degree of variation in surgical decision making for infants with posthemorrhagic hydrocephalus, such as when to temporize, when to shunt, or when to convert. Since much of this clinical decision making is dictated by clinical signs of increased intracranial pressure (including bulging fontanel and splitting of sutures), the authors investigated whether there was variability in how these signs were being assessed by neurosurgeons. They wanted to answer the following question: is there acceptable interrater reliability in the neurosurgical assessment of bulging fontanel and split sutures?

Methods

Explicit written definitions of “bulging fontanel” and “split sutures” were agreed upon with consensus across the HCRN. At 5 HCRN centers, pairs of neurosurgeons independently assessed premature infants in the first 3 months of life for the presence of a split suture and/or bulging fontanel, according to the a priori definitions. Interrater reliability was then calculated between pairs of observers using the Cohen simple kappa coefficient. Institutional board review approval was obtained at each center and at the University of Utah Data Coordinating Center.

Results

A total of 38 infants were assessed by 13 different raters (10 faculty, 2 fellows, and 1 resident). The kappa for bulging fontanel was 0.65 (95% CI 0.41–0.90), and the kappa for split sutures was 0.84 (95% CI 0.66–1.0). No complications from the study were encountered.

Conclusions

The authors have found a high degree of interrater reliability among neurosurgeons in their assessment of bulging fontanel and split sutures. While decision making may vary, the clinical assessment of this cohort appears to be consistent among these physicians, which is crucial for prospective studies moving forward.

Abbreviations used in this paper:

HCRN = Hydrocephalus Clinical Research Network; ICP = intracranial pressure.
  • Collapse
  • Expand
  • 1

    Amiel-Tison C, , Gosselin J, & Infante-Rivard C: Head growth and cranial assessment at neurological examination in infancy. Dev Med Child Neurol 44:643648, 2002

    • Search Google Scholar
    • Export Citation
  • 2

    Cohen J: A coefficient of agreement for nominal scales. Educ Psychol Meas 20:3746, 1960

  • 3

    Kaiser AM, & Whitelaw AG: Intracranial pressure estimation by palpation of the anterior fontanelle. Arch Dis Child 62:516517, 1987

  • 4

    Simard MN, , Lambert J, , Lachance C, , Audibert F, & Gosselin J: Interexaminer reliability of Amiel-Tison neurological assessments. Pediatr Neurol 41:347352, 2009

    • Crossref
    • Search Google Scholar
    • Export Citation

Metrics

All Time Past Year Past 30 Days
Abstract Views 1318 228 12
Full Text Views 179 14 0
PDF Downloads 288 18 0
EPUB Downloads 0 0 0