Does the patient appear acutely or chronically ill? An interobserver study of global assessments of hospital patients.

The general appearance of 201 patients was assessed by a team of observers. Each patient was seen by two experienced physicians, two junior physicians and two medical students who stated whether the patients did not appear ill or whether the patient appeared acutely or chronically ill. The interobserver variation was considerable and the kappa-values ranged from around 0 to 0.75. The level of agreement did not seem to depend on the clinical experience of the observers. One experienced clinician assessed the patients differently from the others.