Exploring the King’s outcome scale for childhood head injury in children attending a rehabilitation hospital

Peter Rumney, Ryan Hung, Laura McAdam, Arthur Ameis, Michel Lacerte, Pierre Côté, John David Cassidy, Eleanor Boyle, Dayna Greenspoon

Publikation: Bidrag til tidsskriftKonferenceabstrakt i tidsskriftForskningpeer review


Objective: Few tools exist to assess and monitor impairment and disability in children with acquired brain injury. The King’s Outcome Scale for Childhood Head Injury (KOSCHI) was developed as an alternative to the Glasgow Outcome Scale. However, limited information is available to support its reliability, validity and responsiveness. A pilot study was designed to (1) develop a KOSCHI data collection form; and (2) determine the feasibility of studying its intra-rater and inter-rater reliability in children with acquired brain injury.

Methods: A KOSCHI data collection form was developed after reviewing the literature. Two paediatricians and one paediatric neurologist tested its use in a clinical setting and the form was modified. As a pilot study, a rehabilitation paediatrician then assessed 10 children (aged 5–18 years) with acquired brain injuries (six traumatic, four non-traumatic) and completed a KOSCHI data collection form and assigned a KOSCHI score. After joint training, three additional physicians (one pediatrician, two community physiatrists) independently reviewed the completed KOSCHI data collection form and assigned a KOSCHI score. Each physician was blinded to each other’s scores. A reiterative process was undertaken to discuss the scoring process and revise the KOSCHI data collection form.

Results: The percentage agreement within and between examiners was 60% and 70%, respectively. The primary scoring discrepancies concerned KOSCHI 4a vs 4b (low vs high moderate disability) and 4b vs 5a (moderate disability vs good recovery).

Conclusions: Initial pilot evaluation suggests moderate agreement at best within and between raters. These findings suggest: (1) better training is needed to improve rater agreement and (2) revisions to the KOSCHI data collection form are necessary to enhance clarity of the collected information and reduce rater disagreement over assigning a KOSCHI score at the moderate disability and good recovery levels. Previous studies used patient charts to assign KOSCHI scores. Clinicians vary in their note-taking when conducting a history and this could have resulted in the moderate agreement levels found in past literature. It is believed that the use of a KOSCHI data collection form as an interview guide will increase level of agreement, as it will enable clinicians to record all the issues that are needed to assign a KOSCHI score. The revised KOSCHI data collection form will undergo additional pilot testing. These pilots are part of a larger prospective cohort study that examines KOSCHI intra-rater and inter-rater reliability, whether the different levels of the KOSCHI correlate with other outcome measures of overall health status and whether the KOSCHI can detect changes in outcome over time. It is expected that these research projects will expand the use of the KOSCHI and maximize its clinical reliability.

Artikelnummer# 0348
TidsskriftBrain Injury
Udgave nummer5-6
Antal sider1
StatusUdgivet - 2014
BegivenhedTenth World Congress on Brain Injury - San Francisco, USA
Varighed: 19. mar. 201422. mar. 2014


KonferenceTenth World Congress on Brain Injury
BySan Francisco


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