Lash Timothy L, Fox Matthew P, Thwin Soe Soe, Geiger Ann M, Buist Diana S M, Wei Feifei, Field Terry S, Yood Marianne Ulcickas, Frost Floyd J, Quinn Virginia P, Prout Marianne N, Silliman Rebecca A
Boston University School of Public Health, Boston, MA 02118, USA.
Am J Epidemiol. 2007 Jun 15;165(12):1454-61. doi: 10.1093/aje/kwm034. Epub 2007 Apr 3.
The quality of medical record abstracts is often characterized in a reliability substudy. These results usually indicate agreement, but not the extent to which lack of agreement affects associations observed in the complete data. In this study, medical records were reviewed and abstracted for patients diagnosed with stage I or stage II breast cancer between 1990 and 1994 at one of six US Cancer Research Network sites. For a subsample, interrater reliability data were available. The authors calculated conventional hazard ratios and 95% confidence intervals for the association of demographic, tumor, and treatment characteristics with recurrence rate. These conventional estimates of effect were compared with three sets of estimates and 95% simulation intervals that took account of the uncertainty assessed by lack of agreement in the reliability substudy. The rate of recurrence was associated with increasing cancer stage and with treatment modality but not with demographic characteristics. The hazard ratios and simulation intervals that took account of the reliability data showed that the simulation interval grew wider as the sources of uncertainty taken into account grew more complete, but the associations expected a priori remained readily apparent. While many investigators use reliability data only as a metric for data quality, a more thorough approach can also quantitatively depict the uncertainty in the observed associations.
病历摘要的质量通常在可靠性子研究中得到表征。这些结果通常表明一致性，但并未表明不一致程度对在完整数据中观察到的关联的影响程度。在本研究中，对1990年至1994年期间在美国癌症研究网络六个站点之一被诊断为I期或II期乳腺癌的患者的病历进行了审查和摘要提取。对于一个子样本，可获得评分者间可靠性数据。作者计算了人口统计学、肿瘤和治疗特征与复发率之间关联的传统风险比和95%置信区间。将这些传统的效应估计值与考虑了可靠性子研究中因不一致性评估出的不确定性的三组估计值和95%模拟区间进行了比较。复发率与癌症分期增加以及治疗方式有关，但与人口统计学特征无关。考虑了可靠性数据的风险比和模拟区间表明，随着所考虑的不确定性来源变得更加完整，模拟区间会变宽，但先验预期的关联仍然很明显。虽然许多研究者仅将可靠性数据用作数据质量的衡量标准，但一种更全面的方法还可以定量描述观察到的关联中的不确定性。
