Development and inter-rater reliability of a simple prehospital mobility score for use in emergency patients

TL;DR

This study created a simple mobility score for emergency patients in ambulances and found it has high agreement among ambulance staff.

Contribution

A new prehospital mobility score was developed and shown to have high inter-rater reliability.

Findings

The prehospital mobility score had 80.5% agreement between paramedics.

Inter-rater agreement between paramedics and observers was high with a kappa of 0.82.

The score was feasible and reliable in real ambulance settings across three regions.

Abstract

Mobility assessment enhances the ability of vital sign-based early warning scores to predict risk. Currently mobility is not routinely assessed in a standardized manner in Denmark during the ambulance transfer of unselected emergency patients. The aim of this study was to develop and test the inter-rater reliability of a simple prehospital mobility score for pre-hospital use in ambulances and to test its inter-rater reliability.

Following a pilot study, we developed a 4-level prehospital mobility score based of the question”How much help did the patient need to be mobilized to the ambulance trolley”. Possible scores were no-, a little-, moderate-, and a lot of help. A cross-sectional study of inter-rater agreement among ambulance personnel was then carried out. Paramedics on ambulance runs in the North- and Central Denmark Region, as well as The Fareoe Islands, were included as a convenience sample between July 2020—May 2021. The simple prehospital mobility score was tested, both by the paramedics in the ambulance and by an additional observer. The study outcomes were inter-rater agreements by weighted kappa between the paramedics and between observers and paramedics.

We included 251 mobility assessments where the patient mobility was scored. Paramedics agreed on the mobility score for 202 patients (80,5%). For 47 (18.7%), there was a deviation of one between scores, in two (< 1%) there was a deviation of two and none had a deviation of three (Table 1).

Inter-rater agreement between paramedics in all three regions showed a kappa-coefficient of 0.84 (CI 95%: 0.79;0.88). Between observers and paramedics in North Denmark Region and Faroe Islands the kappa-coefficient was 0.82 (CI 95%: 0.77;0.86).

We developed a simple prehospital mobility score, which was feasible in a prehospital setting and with a high inter-rater agreement between paramedics and observers.

The online version contains supplementary material available at 10.1186/s12873-024-00944-9.

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