Coelho Neto M A, Roncato P, Nastri C O, Martins W P
Department of Obstetrics and Gynecology, Ribeirao Preto Medical School, University of Sao Paulo (DGO-FMRP-USP), Ribeirao Preto, Brazil.
School of Health Technology - Ultrasonography School of Ribeirao Preto (FATESA-EURP), Ribeirao Preto, Brazil.
Ultrasound Obstet Gynecol. 2015 Jul;46(1):14-20. doi: 10.1002/uog.14654. Epub 2015 Jun 4.
To examine the quality of methods used and the accuracy of the interpretation of agreement in existing studies that examine the reliability of ultrasound measurements and judgments in obstetrics and gynecology.
A systematic search of MEDLINE was performed on 25 March 2014, looking for studies that examined the reliability of ultrasound measurements and judgments in obstetrics and gynecology with evaluation of concordance (CCC) or intraclass (ICC) correlation coefficients or kappa as a main objective.
Seven hundred and thirty-three records were examined on the basis of their title and abstract, of which 141 full-text articles were examined completely for eligibility. We excluded 29 studies because they did not report CCC/ICC/kappa, leaving 112 studies that were included in our analysis. Two studies reported both ICC and kappa and were counted twice, therefore, the number used as the denominator in the analyses was 114. Only 16/114 (14.0%) studies were considered to be well designed (independent acquisition and blinded analysis) and to have interpreted the results properly. Most errors occurring in the studies are likely to overestimate the reliability of the method examined.
The vast majority of published studies examined had important flaws in design, interpretation and/or reporting. Such limitations are important to identify as they might create false confidence in the existing measurements and judgments, jeopardizing clinical practice and future research. Specific guidelines aimed at improving the quality of reproducibility studies that examine ultrasound methods should be encouraged.
考察现有研究中所使用方法的质量以及对一致性解释的准确性，这些研究旨在检验妇产科超声测量及判断的可靠性。
于2014年3月25日对MEDLINE进行系统检索，查找以评估一致性相关系数（CCC）或组内相关系数（ICC）或kappa系数作为主要目标来检验妇产科超声测量及判断可靠性的研究。
基于标题和摘要对733条记录进行了审查，其中141篇全文文章被全面审查以确定是否符合纳入标准。我们排除了29项研究，因为它们未报告CCC/ICC/kappa系数，剩下112项研究纳入我们的分析。两项研究同时报告了ICC和kappa系数，因此在分析中被计算了两次，所以分析中用作分母的数量为114。只有16/114（14.0%）的研究被认为设计良好（独立采集和盲法分析）且对结果解释正确。研究中出现的大多数错误可能会高估所检验方法的可靠性。
绝大多数已发表的研究在设计、解释和/或报告方面存在重大缺陷。识别这些局限性很重要，因为它们可能会在现有测量和判断中产生错误的信心，危及临床实践和未来研究。应鼓励制定旨在提高检验超声方法的重复性研究质量的具体指南。
