Brain Disease Research Center, Korea Institute of Oriental Medicine, Daejeon, Republic of Korea.
J Altern Complement Med. 2013 Jan;19(1):29-34. doi: 10.1089/acm.2011.0612. Epub 2012 Sep 6.
The aim of this study was to evaluate the reliability between observers with regard to pulse signs that are observed by Traditional Korean Medicine (TKM) clinicians.
A total 658 patients with stroke who were admitted into Oriental medical university hospitals from February 2010 through December 2010 were included in this study. Each patient was seen independently by 2 experts from the same department for an examination of the pulse signs. Interobserver reliability was measured using three methods: simple percentage agreement, the κ value, and the AC(1) statistic.
The κ value indicated that the interobserver reliability in evaluating the pulse signs of the subjects ranged from poor to moderate, whereas the AC(1) analysis revealed that agreement between the 2 experts was generally high (with the exception of slippery pulse). The κ value indicated that the interobserver reliability for assessing subjects who garnered the same opinion between the raters was generally moderate to good (with the exceptions of rough pulse and sunken pulse) and that the AC(1) measure of agreement between the 2 experts was generally high.
Pulse diagnosis is regarded as one of the most important procedures in TKM, despite the aforementioned limitations. This study reveals that the interobserver reliability in making a pulse diagnosis in stroke patients is not particularly high when objectively quantified. Additional research is needed to help reduce this lack of reliability for various portions of the pulse diagnosis.
本研究旨在评估传统韩国医学（TKM）临床医生观察到的脉象观察者之间的可靠性。
本研究共纳入 2010 年 2 月至 2010 年 12 月期间入住东方医科大学附属医院的 658 例脑卒中患者。每位患者均由同一部门的 2 名专家独立进行脉象检查。采用简单百分比一致性、κ 值和 AC(1)统计量三种方法测量观察者间可靠性。
κ 值表明，评估患者脉象的观察者间可靠性从差到中等不等，而 AC(1)分析表明，两位专家之间的一致性通常较高（滑脉除外）。κ 值表明，评估获得两位评估者相同意见的患者的观察者间可靠性通常为中等至良好（粗糙脉和沉脉除外），两位专家之间的 AC(1)测量一致性通常较高。
尽管存在上述局限性，但脉诊被认为是 TKM 中最重要的程序之一。本研究表明，脑卒中患者脉诊的观察者间可靠性在客观量化时并不是特别高。需要进一步研究来帮助减少脉诊各个部分的这种可靠性不足。
