Inter- and Intra-rater Reliability of Neck Circumference Measurements in Children

Rationale: Increased neck circumference is a risk factor for obstructive sleep apnea in adults. With rising obesity prevalence in children, it may be an important identifier of obstructive sleep apnea in children. The reliability of measuring neck circumference in children has not been systematically evaluated.

Objective: To determine the inter- and intra-rater reliability of neck circumference measurements in children aged 2-16 years.

Methods: Children aged 2-16 years with limb fractures were recruited. Neck circumference was measured by three investigators each using two separate unmarked paper tapes in the 2-5 year age group (N = 43), and three separate tapes in the 6-10 and 11-16 year age groups (N = 18 and 40).

Results: Neck circumference measurements showed excellent inter-rater reliability for children 6-10 and 11-16 years (ICC = 0.952 and 0.989). Substantial variation was observed for the 2-5 year age group (ICC = 0.701). Good intra-rater reliability was demonstrated for the three groups (ICC range: 0.776, 0.950). Repeatability coefficients were 2.5-3.4 cm in the youngest age group and were 1.2-1.4 cm in the 6-16 year age group.

Conclusion: In children 6-16 years old, neck circumference shows very good inter and good intra-rater reliability. Multiple measurements are not required for precision and reliability.