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Assessment of the grimace component of a coma scale
  1. C R J C NEWTON, Senior Lecturer in Paediatric Neurosciences and International Child Health
  1. Institute of Child Health, London WC1N 2AP, UK

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    Editor,—While I applaud Tatman et al’s attempt to test James’s modification of the Glasgow coma scale for use in intubated children,1 I have some concerns about their study. First, as some of the observations are on the same child, and the attending nurse may have had some knowledge of the child’s condition before the assessment, the observations are not independent and thus may not occur by chance (the basis of Cohen’s κ2). Second, Cohen’s κ and weighted κ (derived from Cohen’s κ) are sensitive to an unequal distribution of the marginal totals,3 which are present in this study. Third, the verbal and grimace scales were not performed on the same group of patients, further …

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