Division of Pediatric Gastroenterology, Hepatology and Nutrition, Children's Memorial Hospital, Northwestern University, Chicago, Illinois 60614, USA.
Am J Gastroenterol. 2010 Dec;105(12):2697-701. doi: 10.1038/ajg.2010.350. Epub 2010 Aug 31.
Functional gastrointestinal disorders (FGIDs) are common in children. Diagnosis of these conditions is based on the pediatric Rome criteria. In the past, we have shown that there was low inter-rater reliability (IRR) among pediatric gastroenterologists using the Rome II criteria. Since then, a new version of the criteria has been issued. The reliability of the Rome III criteria has not been established.
A total of 10 pediatric gastroenterologist specialists and 10 pediatric gastroenterology fellows were provided with 20 clinical vignettes and a list of 17 possible diagnoses (all pediatric categories of the Rome criteria plus "none of the above" or "not enough information") and instructed to select one or more diagnosis for each vignette.
The average percentage of agreement among the raters was 50% for the pediatric gastroenterologists and 45% for the pediatric gastroenterology fellows. The inter-rater percentage of agreement per clinical case was >50% in only 7 out of 20 (35%) vignettes for the gastroenterologists and only 6 out of 20 (30%) cases for the fellows. The inter-rater percentage of agreement was <25% in 2 out of 20 (10%) vignettes for the gastroenterologists and 4 out of 20 (20%) vignettes for the fellows. The κ coefficient was 0.45 for the specialists (P<0.0001) and 0.39 for the fellows (P<0.0001). In a subanalysis of the groups of pain and constipation-related disorders, the inter-rater percentage of agreement per clinical case ranged between 27 and 100% (mean 57%, κ=0.37, P<0.0001) for the gastroenterologists and between 36 and 80% (mean 52%, κ=0.33, P<0.0001) for the fellows in the constipation subgroup. The inter-rater percentage of agreement per clinical case for the pain subgroup ranged between 22 and 80% (mean 48%, κ=0.36, P<0.0001) for the gastroenterologists and 22 and 62% (mean 39%, κ=0.29, P<0.0001) for the fellows in the pain subgroup. The κ coefficient for specialists with expertise in FGIDs was 0.37 (P<0.0001) and for those with expertise in other gastroenterology conditions was 0.53 (P<0.0001).
The IRR among pediatric gastroenterologists and fellows was found to be fair to moderate for the Rome III criteria. Only slight to fair agreement between raters existed for important subcategories of pain and constipation. The results from our current study are almost similar to that of the IRR study done for the Rome II criteria. This indicates the need for further refinement of the Rome criteria to make them more encompassing and user friendly.
功能性胃肠病（FGIDs）在儿童中很常见。这些疾病的诊断基于儿科罗马标准。过去，我们已经表明，使用罗马 II 标准的儿科胃肠病学家之间的观察者间可靠性（IRR）较低。此后，发布了新的标准版本。罗马 III 标准的可靠性尚未确定。
总共向 10 名儿科胃肠病专家和 10 名儿科胃肠病学研究员提供了 20 个临床病例和 17 个可能诊断的列表（罗马标准的所有儿科类别加“无上述情况”或“信息不足”），并指示他们为每个病例选择一个或多个诊断。
对于儿科胃肠病学家，评分者之间的平均百分比一致性为 50%，对于儿科胃肠病学研究员，平均百分比一致性为 45%。在 20 个病例中，每个病例的观察者间百分比一致性>50%的仅为 7 个（35%）病例对于胃肠病学家，只有 6 个（30%）病例对于研究员。对于胃肠病学家，有 2 个（10%）病例和研究员的 4 个（20%）病例的观察者间百分比一致性<25%。专家的 κ 系数为 0.45（P<0.0001），研究员为 0.39（P<0.0001）。在疼痛和便秘相关疾病组的亚分析中，每个临床病例的观察者间百分比一致性范围为 27%至 100%（平均 57%，κ=0.37，P<0.0001）对于胃肠病学家和在便秘亚组中，从 36%到 80%（平均 52%，κ=0.33，P<0.0001）对于研究员。在疼痛亚组中，每个临床病例的观察者间百分比一致性范围为 22%至 80%（平均 48%，κ=0.36，P<0.0001）对于胃肠病学家和在疼痛亚组中，从 22%到 62%（平均 39%，κ=0.29，P<0.0001）对于研究员。具有 FGIDs 专业知识的专家的 κ 系数为 0.37（P<0.0001），具有其他胃肠病学专业知识的专家的 κ 系数为 0.53（P<0.0001）。
发现儿科胃肠病学家和研究员之间的 IRR 对于罗马 III 标准为中等至良好。对于疼痛和便秘的重要亚类，评分者之间只有轻微至中等的一致性。我们当前研究的结果几乎与罗马 II 标准的 IRR 研究结果相似。这表明需要进一步细化罗马标准，使其更具包容性和用户友好性。
