Inter-Rater Reliability of Historical Data Collected by Non-Medical Research Assistants and Physicians in Patients with Acute Abdominal Pain

OBJECTIVES: In many academic emergency departments (ED), physicians are asked to record clinical data for research that may be time consuming and distracting from patient care. We hypothesized that non-medical research assistants (RAs) could obtain historical information from patients with acute abdominal pain as accurately as physicians.METHODS: Prospective comparative study conducted in an academic ED of 29 RAs to 32 resident physicians (RPs) to assess inter-rater reliability in obtaining historical information in abdominal pain patients. Historical features were independently recorded on standardized data forms by a RA and RP blinded to each others' answers. Discrepancies were resolved by a third person (RA) who asked the patient to state the correct answer on a third questionnaire, constituting the "criterion standard." Inter-rater reliability was assessed using kappa statistics (kappa) and percent crude agreement (CrA).RESULTS: Sixty-five patients were enrolled (mean age 43). Of 43 historical variables assessed, the median agreement was moderate (kappa 0.59 [Interquartile range 0.37-0.69]; CrA 85.9%) and varied across data categories: initial pain location (kappa 0.61 [0.59-0.73]; CrA 87.7%), current pain location (kappa 0.60 [0.47-0.67]; CrA 82.8%), past medical history (kappa 0.60 [0.48-0.74]; CrA 93.8%), associated symptoms (kappa 0.38 [0.37-0.74]; CrA 87.7%), and aggravating/alleviating factors (kappa 0.09 [-0.01-0.21]; CrA 61.5%). When there was disagreement between the RP and the RA, the RA more often agreed with the criterion standard (64% [55-71%]) than the RP (36% [29-45%]).CONCLUSION: Non-medical research assistants who focus on clinical research are often more accurate than physicians, who may be distracted by patient care responsibilities, at obtaining historical information from ED patients with abdominal pain

STUDIES ON THE MECHANISM OF PROTEINURIA

In the chronic active stage of hemorrhagic Bright's disease there are often comparatively long intervals when the amount of functioning kidney tissue decreases very slowly and when there is no marked variation in glomerular permeability. With the patient on a standard regime the urea clearance remains constant, proteinuria fairly so, and blood samples taken under basal conditions with precautions against stasis and effects of posture contain nearly constant percentages of plasma proteins (18). Under such circumstances, some of the factors governing proteinuria may be studied. The amount of protein in the urine, as well as its level in the circulating plasma, seems to depend largely upon the nature and severity of injury to the glomerular capillaries (14). Proteinuria may also be influenced in a moderate degree by the level of protein in the diet (4, 11, 18). In addition to these factors there are apparently others which induce temporary fluctuations in proteinuria. The observations reported here were made in an effort to clarify the problem further. Our results support the concept that the quantity of protein lost in the urine is related to the amount of glomerular filtrate formed and to the rate of production of serum proteins. METHODS Subjects. The investigations were conducted on four patients with chronic active hemorrhagic Bright's disease. Three of these had served as subjects for previous studies and their medical histories have been summarized elsewhere (18, 19). The fourth patient (J. H.) was a married woman of 25 years of age. She had scarlet fever at the age of fourteen. Protein was first discovered in the urine during pregnancy at the age of eighteen. During her twentyfirst year she contracted and received treatment for gonorrhea. Clinical cure of the venereal infection resulted. During her twenty-second and twenty-third years she was ill on several occasions with acute sinusitis. Two months prior to admission her face became swollen, and she was told by a physician that she had Bright's disease