Doré Maxime, Frenette Anne Julie, Chagnon Isabelle, Routhier Nathalie, Williamson David
Maxime Doré, B.Pharm., M.Sc., is Pharmacist, Department of Pharmacy, Hôpital du Sacré-Coeur de Montréal, Montréal, Quebec, Canada. Anne Julie Frenette, B.Pharm., M.Sc., is Assistant Clinical Professor, Associate Researcher, and Critical Care Pharmacist, Department of Pharmacy and Research Center, Hôpital du Sacré-Coeur de Montréal, and Faculty of Pharmacy, University of Montreal. Isabelle Chagnon, M.D., FRCPC, is Specialist, Internal Medicine, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, and Clinical Professor of Medicine, Faculty of Medicine, University of Montreal. Nathalie Routhier, M.D., M.Sc., FRCPC, is Specialist, Internal Medicine, Department of Medicine, Hôpital du Sacré-Coeur de Montréal, and Clinical Professor of Medicine, Faculty of Medicine, University of Montreal. David Williamson, B.Pharm., M.Sc., BCPS, is Associate Researcher and Critical Care Pharmacist, Department of Pharmacy and Research Center, Hôpital du Sacré-Coeur de Montréal, and Associate Clinical Professor, Faculty of Pharmacy, University of Montreal.
Am J Health Syst Pharm. 2014 Dec 1;71(23):2045-52. doi: 10.2146/ajhp130711.
The interrater reliability of the 4T's method and the HIT expert probability (HEP) score for clinical evaluation of suspected heparin-induced thrombocytopenia (HIT) was investigated.
Patients hospitalized over a three-year period who were tested for HIT via anti-platelet factor 4 (anti-PF4) antigen assay were identified using laboratory data; 127 patient cases met the study inclusion criteria. Nine clinical pharmacists with expertise in HIT management evaluated the 127 cases using two pretest scoring systems: the 4T's score and the HEP score. Each case was independently evaluated using both 4T's and HEP scores. The primary endpoint was interrater agreement of overall 4T's and HEP scores and individual item scores.
Raw agreement of values assigned by the two raters for each of the four items comprising the 4T's score ranged from 0.54 to 0.86, with agreement of 0.63 for final patient categorizations. Raw agreement of rater weightings of the eight HEP scoring items ranged from 0.34 to 1.0; for dichotomization of patients at the suggested screening cutoff value (>2.0), agreement was 0.65. Kappa coefficients were 0.15-0.45 for 4T's item scores and 0.17-0.70 for HEP score item scores. With both scoring systems, low rater agreement mainly related to determination of the timing of thrombocytopenia and possible other causes of the disorder.
In a retrospective study, inter-rater agreement in scoring of HIT probability via the 4T's and HEP scoring systems was relatively low. The HEP score did not increase interrater reliability or correlation with anti-PF4 antibodies compared with the 4T's score.
研究4T法与HIT专家概率（HEP）评分在疑似肝素诱导的血小板减少症（HIT）临床评估中的评分者间信度。
利用实验室数据确定在三年期间住院并通过抗血小板因子4（抗PF4）抗原检测进行HIT检测的患者；127例患者病例符合研究纳入标准。9名具有HIT管理专业知识的临床药剂师使用两种预测试评分系统对127例病例进行评估：4T评分和HEP评分。每个病例分别使用4T评分和HEP评分进行独立评估。主要终点是4T和HEP总分及各单项评分的评分者间一致性。
组成4T评分的四个项目中，两位评分者对每个项目赋值的原始一致性范围为0.54至0.86，最终患者分类的一致性为0.63。HEP评分八个项目的评分者加权原始一致性范围为0.34至1.0；在建议的筛查临界值（>2.0）对患者进行二分法时，一致性为0.65。4T评分项目的kappa系数为0.15 - 0.45，HEP评分项目的kappa系数为0.17 - 0.70。在两种评分系统中，评分者一致性较低主要与血小板减少症发生时间的判定以及该病症可能的其他病因有关。
在一项回顾性研究中，通过4T和HEP评分系统对HIT概率评分的评分者间一致性相对较低。与4T评分相比，HEP评分并未提高评分者间信度或与抗PF4抗体的相关性。
