Reliability of the Sexual Knowledge Picture Instrument: a potential diagnostic instrument for sexual abuse in young children.

OBJECTIVE: To determine the intra-rater and inter-rater reliability of the Sexual Knowledge Picture Instrument (SKPI), a potential diagnostic instrument for young suspected victims of sexual abuse containing three scoring forms, that is, verbal responses, non-verbal reactions and red flags. DESIGN: Video-recorded SKPI interviews with children with and without suspicion of child sexual abuse were observed and scored by two trained, independent raters. The second rater repeated the assessment 6 weeks after initial rating to evaluate for intra-rater reliability. SUBJECTS: 78 children aged 3-9 years old were included in the study. 39 of those included had known suspicion of sexual abuse and the other 39 had no suspicion. MAIN OUTCOME MEASURES: Intra-rater and inter-rater reliability of the scores per study group and in the total sample were assessed by Cohen's kappa and percentage of agreement (POA). RESULTS: The median intra-rater Cohen's kappa exceeded 0.90 and the POA exceeded 95 for all three forms in both study groups, except for the red flag form (median Cohen's kappa 0.54 and POA 87 in the suspected group, and 0.84 and 92, respectively, in the total sample). For the verbal scoring form the median inter-rater Cohen's kappa and POA were 1.00 and 100, respectively, in both groups. For the non-verbal form the median inter-rater kappa and POA were 0.37 and 97, respectively, in the suspected group, and 0.47 and 100, respectively, in the control group. For the red flag form, they were 0.37 and 76, respectively, in the suspected group and 0.42 and 77, respectively, in the control group. CONCLUSION: The reliability of the SKPI verbal form was sufficient, but there is room for improvement in the non-verbal and red flag scoring forms. These forms may be improved by adjusting the manual and improving rater training.

Feasibility and acceptability of the 'Acutely Presenting Older Patient' screener in routine emergency department care.

BACKGROUND: risk stratification tools for older patients in the emergency department (ED) have rarely been implemented successfully in routine care. OBJECTIVE: to evaluate the feasibility and acceptability of the 'Acutely Presenting Older Patient' (APOP) screener, which identifies older ED patients at the highest risk of adverse outcomes within 2 minutes at presentation. DESIGN AND SETTING: 2-month prospective cohort study, after the implementation of the APOP screener in ED routine care in the Leiden University Medical Center. SUBJECTS: all consecutive ED patients aged ≥70 years. METHODS: feasibility of screening was assessed by measuring the screening rate and by identifying patient- and organisation-related determinants of screening completion. Acceptability was assessed by collecting experienced barriers of screening completion from triage-nurses. RESULTS: we included 953 patients with a median age of 77 (IQR 72-82) years, of which 560 (59%) patients were screened. Patients had a higher probability of being screened when they had a higher age (OR 1.03 (95%CI 1.01-1.06), P = 0.017). Patients had a lower probability of being screened when they were triaged very urgent (OR 0.55 (0.39-0.78), P = 0.001) or when the number of patients upon arrival was high (OR 0.63 (0.47-0.86), P = 0.003). Experienced barriers of screening completion were patient-related ('patient was too sick'), organisation-related ('ED was too busy') and personnel-related ('forgot to complete screening'). CONCLUSION: with more than half of all older patients screened, feasibility and acceptability of screening in routine ED care is very promising. To further improve screening completion, solutions are needed for patients who present with high urgency and during ED rush hours.