Sinabulya Helen, Holmberg A, Blomgren L
Department of Surgery, Capio S:t Gorans Hospital, Stockholm, Sweden
Venous Centre, Stockholm, Sweden.
Phlebology. 2015 Feb;30(1):61-5. doi: 10.1177/0268355513515474. Epub 2013 Dec 6.
The clinical class C, of the CEAP classification (Clinical-Etiology-Anatomy-Pathophysiology), is often used when selecting patients for treatment within the national healthcare system. The aim of this study was to test the interobserver reproducibility of C when used in a clinical situation where the decision for reimbursement was made.
An unselected series of 78 patients (106 limbs) with varicose veins were examined by three independent surgeons with regard to C of CEAP and whether there was a medical indication for treatment. Interobserver reproducibility was calculated with kappa statistic.
Total agreement between the three observers for clinical class was obtained in 61% of all cases (κ .55-.68 (95% CI)) and for medical indication in 60% of all cases (κ.35-.57 (95% CI)).
The reproducibility of C when deciding medical indication for treatment is moderate. This may be due to inherent difficulties in the CEAP, lack of specific training, or the simultaneous assessment of reimbursement that may influence the clinical classification.
在国家医疗体系中选择治疗患者时，常使用CEAP分类（临床-病因-解剖-病理生理学）中的临床C级。本研究的目的是测试在做出报销决定的临床情况下使用C级时观察者间的可重复性。
三位独立的外科医生对78例（106条肢体）未选择的静脉曲张患者进行了检查，评估其CEAP的C级以及是否有治疗的医学指征。使用kappa统计量计算观察者间的可重复性。
三位观察者在所有病例的61%中对临床分级达成了完全一致（κ.55-.68（95%CI）），在所有病例的60%中对医学指征达成了完全一致（κ.35-.57（95%CI））。
在决定治疗的医学指征时，C级的可重复性中等。这可能是由于CEAP本身存在困难、缺乏特定培训，或同时进行的报销评估可能影响临床分级。
