Gowda Meghana, Kit Laura Chang, Stuart Reynolds W, Wang Li, Dmochowski Roger R, Kaufman Melissa R
Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, B-1100 Medical Center North, Nashville, TN, 37232, USA,
Int Urogynecol J. 2013 Oct;24(10):1671-8. doi: 10.1007/s00192-013-2078-y. Epub 2013 Mar 28.
To unify and organize reporting, an International Urogynecological Association (IUGA)/International Continence Society (ICS) expert consortium published terminology guidelines with a classification system for complications related to implants used in female pelvic surgery. We hypothesize that the complexity of the codification system may be a hindrance to precision, especially with decreasing levels of postgraduate expertise.
Residents, fellows, and attending physicians were asked to code seven test cases taken from published literature. Category, timing, and site components of the classification system were assessed independently and according to the level of training. Interobserver reliability was calculated as percent agreement and Fleiss' kappa statistic.
A total of 24 participants (6 attending physicians, 3 fellows, and 15 residents) were tested. The percent agreement showed significant variation when classified by level of training. In all categories, attending physicians had the greatest percentage agreement and largest kappa. The most agreement was seen when attending physicians classified mesh complications by time, 71% agreement with kappa 0.73 [95% confidence interval (CI) 0.58-0.88]. For the same task, the percentage agreement for fellows was 57%, kappa 0.55 (95% CI 0.23-0.87) and with residents 57%, kappa 0.71([95% CI 0.64-0.78). Interestingly, the site component of the classification system had the least overall agreement and lowest kappa [0%, kappa 0.29 (95% CI 0.26-0.32)] followed by the category component [14%, kappa 0.48 (95% CI 0.46-0.5)].
The IUGA/ICS mesh complication classification system has poor interobserver reliability. This trended downward with decreasing postgraduate level; however, we did not have sufficient statistical power to show an association when stratifying by all training levels. This highlights the complex nature of the classification system in its current form and its limitation for widespread clinical and research application.
为了统一和规范报告，国际尿控协会（IUGA）/国际尿失禁学会（ICS）专家联盟发布了术语指南以及女性盆腔手术植入物相关并发症的分类系统。我们假设编码系统的复杂性可能会妨碍准确性，尤其是随着研究生专业水平的降低。
要求住院医师、专科住院医师和主治医师对从已发表文献中选取的7个测试病例进行编码。根据培训水平独立评估分类系统的类别、时间和部位组成部分。观察者间信度以一致百分比和Fleiss卡方统计量计算。
共测试了24名参与者（6名主治医师、3名专科住院医师和15名住院医师）。按培训水平分类时，一致百分比显示出显著差异。在所有类别中，主治医师的一致百分比最高，卡方值最大。当主治医师按时间对网片并发症进行分类时，一致性最高，一致百分比为71%，卡方值为0.73[95%置信区间（CI）0.58 - 0.88]。对于相同任务，专科住院医师的一致百分比为57%，卡方值为0.55（95% CI 0.23 - 0.87），住院医师为57%，卡方值为0.71（95% CI 0.64 - 0.78）。有趣的是，分类系统的部位组成部分总体一致性最低，卡方值最低[0%，卡方值0.29（95% CI 0.26 - 0.32）]，其次是类别组成部分[14%，卡方值0.48（95% CI 0.46 - 0.5）]。
IUGA/ICS网片并发症分类系统的观察者间信度较差。随着研究生水平降低，这种情况呈下降趋势；然而，我们没有足够的统计效力在按所有培训水平分层时显示出相关性。这凸显了当前形式下分类系统的复杂性及其在广泛临床和研究应用中的局限性。
