高级别颈动脉狭窄测量与治疗决策的评分者间一致性

Interrater agreement for high grade carotid artery stenosis measurement and treatment decision.

作者信息

Stapf C, Hofmeister C, Hartmann A, Seyfert S, Koch H C, Mohr J P, Marx P, Mast H

机构信息

Stroke Center / The Neurological Institute, Columbia-Presbyterian Medical Center, New York, NY 10032, USA.

出版信息

Eur J Med Res. 2000 Jan 26;5(1):26-31.

PMID:10657286

Abstract

OBJECTIVES

Randomized trials in North America (NASCET, ACAS) and Europe (ECST) have shown a beneficial effect of endarterectomy for patients with high grade carotid artery stenosis. The results of the NASCET and the ECST further suggest that the effect of endarterectomy differed by degree of stenosis, supporting the importance of stenosis measurement as a factor in the decision process regarding surgery. We investigated the interrater agreement for carotid artery stenosis measurements and treatment decision in a post hoc study on patients undergoing carotid surgery.

METHODS

In a one-year series, 45 consecutive patients underwent preoperative conventional cerebral angiography followed by endarterectomy. Using a magnifying eyepiece and applying the two different measurement criteria of the randomized trials, angiograms were re-evaluated post hoc by three masked raters. Intra-class correlation coefficients (ICCs) with one-sided 95% confidence intervals (CIs) were calculated for the estimation of interrater agreement for degree of stenosis. Conger s kappa (k) statistics were used for the estimation of interrater agreement for a dichotomized stenosis evaluation, i.e. therapeutic decision on surgery (cut-off point for symptomatic stenosis: 70%, cut-off point for asymptomatic stenosis: 60%).

RESULTS

ICCs were.74 (CI.63) for NASCET/ACAS criteria and.72 (CI. 59) for ECST criteria. k values were.55 (CI.42) for NASCET/ACAS criteria and.57 (CI.44) for ECST criteria. Disagreement for a therapeutic decision was seen in 6 of 23 symptomatic patients by NASCET criteria, in 2 of 23 symptomatic patients by ECST and in 4 of 22 asymptomatic patients by ACAS criteria.

CONCLUSIONS

Overall, the interrater agreement for stenosis measurements was good. Agreement for therapeutic decisions on carotid surgery, however, was less strong. These findings suggest that accurate stenosis measurement may not suffice for reliable treatment decisions in patients with high grade carotid artery stenosis.

摘要

目的

北美（NASCET、ACAS）和欧洲（ECST）的随机试验表明，动脉内膜切除术对重度颈动脉狭窄患者具有有益效果。NASCET和ECST的结果进一步表明，动脉内膜切除术的效果因狭窄程度而异，这支持了将狭窄测量作为手术决策过程中一个因素的重要性。我们在一项针对接受颈动脉手术患者的事后研究中，调查了颈动脉狭窄测量和治疗决策的评分者间一致性。

方法

在为期一年的系列研究中，45例连续患者在术前行常规脑血管造影，随后接受动脉内膜切除术。使用放大目镜并应用随机试验的两种不同测量标准，三位盲法评分者对血管造影进行事后重新评估。计算组内相关系数（ICC）及单侧95%置信区间（CI），以评估狭窄程度的评分者间一致性。采用康格kappa（k）统计量评估二分法狭窄评估（即手术治疗决策，有症状狭窄的截断点为70%，无症状狭窄的截断点为60%）的评分者间一致性。

结果

NASCET/ACAS标准的ICC为0.74（CI 0.63），ECST标准的ICC为0.72（CI 0.59）。NASCET/ACAS标准的k值为0.55（CI 0.42），ECST标准的k值为0.57（CI 0.44）。根据NASCET标准，23例有症状患者中有6例在治疗决策上存在分歧；根据ECST标准，23例有症状患者中有2例存在分歧；根据ACAS标准，22例无症状患者中有4例存在分歧。