Bendtsen F, Skovgaard L T, Sørensen T I, Matzen P
Department of Medical Hepatology, Hvidovre Hospital, Denmark.
Hepatology. 1990 Mar;11(3):341-7. doi: 10.1002/hep.1840110302.
The interobserver variation in diagnosis and grading of esophageal varices may be ascribed by characteristics of the observers as well as to the patients. Assessment of this variation therefore requires the contributions of multiple observers and patients. Twenty-eight patients with cirrhosis without previous bleeding or known presence of varices were subjected to upper gastrointestinal endoscopy. Each endoscopy was videotaped and shown to 22 endoscopists. The varices were graded on a scale of 0 to 3 according to size. Each endoscopist diagnosed varices in 8 to 20 patients (mean = 15.9). Overall agreement on the presence (grades 1 to 3) or absence (grade 0) of varices was 70%. The average kappa value was 0.38 (standard deviation = 0.16). Discrimination between varices graded 0 to 1 and varices graded 2 to 3 gave a higher kappa value (p less than 0.01) of 0.52 (standard deviation = 0.17). There was a large variation in kappa values (range = -0.025 to 0.975). No significant correlation was observed between kappa values for the two dichotomies (range = 0.16). The kappa values were not related to the experience of the endoscopist. Considerable variation in the agreement on diagnosis and grading of esophageal varices was found. These results must be taken into account in the assessment of trials of prophylaxis of first-time variceal bleeding.
食管静脉曲张诊断和分级过程中观察者之间的差异可能归因于观察者以及患者的特征。因此，评估这种差异需要多名观察者和患者的参与。28例无既往出血史或已知静脉曲张的肝硬化患者接受了上消化道内镜检查。每次内镜检查均进行录像，并向22位内镜医师展示。根据大小将静脉曲张分为0至3级。每位内镜医师诊断了8至20例患者的静脉曲张（平均 = 15.9）。关于静脉曲张存在（1至3级）或不存在（0级）的总体一致性为70%。平均kappa值为0.38（标准差 = 0.16）。区分0至1级静脉曲张和2至3级静脉曲张的kappa值更高（p小于0.01），为0.52（标准差 = 0.17）。kappa值存在很大差异（范围 = -0.025至0.975）。两种二分法的kappa值之间未观察到显著相关性（范围 = 0.16）。kappa值与内镜医师的经验无关。在食管静脉曲张的诊断和分级一致性方面发现了相当大的差异。在评估首次静脉曲张出血预防试验时必须考虑这些结果。
