Van Herzeele I, Aggarwal R, Malik I, Gaines P, Hamady M, Darzi A, Cheshire N, Vermassen F
Department of Thoracic and Vascular Surgery, Ghent University Hospital, Gent, Belgium.
Eur J Vasc Endovasc Surg. 2009 Jul;38(1):1-9. doi: 10.1016/j.ejvs.2009.03.008. Epub 2009 Apr 8.
To develop weighted error-based, generic and procedure-specific rating scales, to validate these scales for video-based assessment during virtual carotid artery stent (CAS) procedures and correlate them with simulator-derived metrics.
A questionnaire was developed to assess the technique during live CAS procedures. Errors were rated from 1 (unimportant) to 5 (life-threatening) by 28 highly experienced CAS (>50 CAS) physicians. Virtual CAS procedure was performed by 21 interventionalists with varied CAS experience. Fluoroscopy screen and hand movements were video-taped, and simulator-derived metrics recorded. Experienced CAS practitioners then rated the video-taped performances using weighted error, generic and procedure-specific rating scales.
Of the 23 errors assessed, 12 were regarded as moderate (score 3), six serious (score 4) and four life-threatening (score 5). The generic rating scale was able to detect significant differences in performance between inexperienced and experienced CAS operators (score 25 vs. 32 respectively, P<0.01). All scoring systems demonstrated good inter-rater reliability (alpha=0.61-0.87). Significant correlations were observed between simulator-derived and video-based scores: weighted error-based score (r: 0.76, P<0.01), generic (r: 0.62, P<0.01) and procedure-specific (r: 0.76, P<0.01) rating scales.
The generic endovascular rating scale differentiated between levels of CAS experience among skilled interventionalists and correlated to simulator-based error scoring.
制定基于加权误差的通用和特定手术评分量表，在虚拟颈动脉支架置入术（CAS）过程中对这些量表进行视频评估验证，并将其与模拟器得出的指标相关联。
制定一份问卷以评估实时CAS手术中的技术。由28位经验丰富（>50例CAS手术）的医生将错误从1分（不重要）评定至5分（危及生命）。21名具有不同CAS经验的介入医生进行虚拟CAS手术。对荧光屏和手部动作进行录像，并记录模拟器得出的指标。经验丰富的CAS手术医生随后使用基于加权误差、通用和特定手术的评分量表对录像表现进行评分。
在评估的23项错误中，12项被视为中度（3分），6项严重（4分），4项危及生命（5分）。通用评分量表能够检测出经验不足和经验丰富的CAS手术医生在操作表现上的显著差异（分别为25分和32分，P<0.01）。所有评分系统均显示出良好的评分者间信度（α=0.61 - 0.87）。在模拟器得出的分数与基于视频的分数之间观察到显著相关性：基于加权误差的分数（r：0.76，P<0.01）、通用分数（r：0.62，P<0.01）和特定手术分数（r：0.76，P<0.01）量表。
通用的血管内评分量表区分了熟练介入医生的CAS经验水平，并与基于模拟器的误差评分相关。
