Liu Honghu, Harker Judith O, Wong Andrew L, Maclean Catherine H, Bulpitt Ken J, Mittman Brian S, Fitzgerald John, Grossman Jennifer, Rubenstein Laurence Z, Hahn Bevra, Paulus Harold E, Kahn Katherine L
UCLA Department of Medicine, Los Angeles, CA 90095-1736, USA.
Semin Arthritis Rheum. 2004 Apr;33(5):302-10. doi: 10.1016/j.semarthrit.2003.09.009.
To evaluate the interrater reliability of rheumatologist diagnosis of rheumatoid arthritis (RA) and the concordance between rheumatologist and computer algorithms for assessing the accuracy of a diagnosis of RA.
Self-reported data regarding symptoms and signs for a diagnosis of RA were considered by a panel of rheumatologists and by computer algorithms to assess the probability of a diagnosis of RA for 90 patients. The rheumatologists' review was validated through medical record.
The interrater reliability among rheumatologists regarding a diagnosis of RA was 84%; the chance-corrected agreement (kappa) was 0.66. Agreement between the rheumatologists' rating and the best-performing algorithm was 95%. Using rheumatologist's review as a standard, the sensitivity of the algorithm was 100%, specificity was 88%, and the positive predictive value was 91%. The validation of rheumatologist's review by medical record showed 81% sensitivity, 60% specificity, and 78% positive predictive value.
Reliability of rheumatologists' assignment of a diagnosis of RA by using self-report data is good. Algorithms defining symptoms as either joint swelling or tenderness with symptom duration >or=4 weeks have a better agreement with rheumatologist's diagnosis than do ones relying on a longer symptom duration.
These findings have important implications for health services research and quality improvement interventions pertinent to case finding for RA through self-report data.
评估风湿病学家对类风湿关节炎（RA）诊断的评分者间信度，以及风湿病学家与计算机算法在评估RA诊断准确性方面的一致性。
一组风湿病学家和计算机算法通过考虑自我报告的有关RA诊断的症状和体征数据，来评估90例患者患RA的可能性。通过病历对风湿病学家的评估进行验证。
风湿病学家之间对RA诊断的评分者间信度为84%；校正机遇一致率（kappa）为0.66。风湿病学家的评分与表现最佳的算法之间的一致性为95%。以风湿病学家的评估为标准，该算法的敏感性为100%，特异性为88%，阳性预测值为91%。通过病历对风湿病学家评估的验证显示，敏感性为81%，特异性为60%，阳性预测值为78%。
风湿病学家使用自我报告数据对RA进行诊断的可靠性良好。将症状定义为关节肿胀或压痛且症状持续时间≥4周的算法，与风湿病学家的诊断一致性优于依赖更长症状持续时间的算法。
这些发现对通过自我报告数据进行RA病例发现的卫生服务研究和质量改进干预具有重要意义。
