Walsh Catharine M, Ling Simon C, Mamula Petar, Lightdale Jenifer R, Walters Thomas D, Yu Jeffrey J, Carnahan Heather
*Department of Paediatrics, Division of Gastroenterology, Hepatology and Nutrition, The Hospital for Sick Children, University of Toronto, Ontario, Canada †Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, PA ‡Department of Pediatrics, Division of Pediatric Gastroenterology and Nutrition, UMass Memorial Children's Medical Center, University of Massachusetts, Worcester, MA §Wilson Centre, Faculty of Medicine, University of Toronto, Ontario ||School of Human Kinetics and Recreation, Memorial University of Newfoundland, St John's, Newfoundland, Canada.
J Pediatr Gastroenterol Nutr. 2015 Apr;60(4):474-80. doi: 10.1097/MPG.0000000000000686.
Validated assessment tools are required to support competency-based education. We aimed to assess the reliability and validity of the Gastrointestinal Endoscopy Competency Assessment Tool for Pediatric Colonoscopy (GiECATKIDS), an instrument developed by 41 North American experts using Delphi methodology.
GiECATKIDS consists of a 7-item global rating scale (GRS) and an 18-item checklist (CL). An attending physician assessed 104 colonoscopies performed at 3 North American hospitals by 56 endoscopists, including 25 novices (<50 previous procedures), 21 intermediates (50-250), and 10 advanced endoscopists (>500). Another observer rated procedures to assess interrater reliability using intraclass correlation coefficient (ICC). Test-retest reliability was measured with ICC comparing endoscopists' first and second procedure scores. Discriminative validity was examined by comparing experience level with scores. Concurrent validity was assessed by correlating scores with colonoscopy experience, cecal and terminal ileal intubation rates, and physician global assessment.
Interrater reliability of the GiECATKIDS was high (total: ICC = 0.88; GRS: ICC = 0.79; CL: ICC = 0.89). Test-retest reliability was excellent (total: ICC = 0.94; GRS: ICC = 0.94; CL: ICC = 0.84). GiECATKIDS total, GRS, and CL scores differed significantly among novice, intermediate, and advanced endoscopists (P < 0.001). There was a significant positive correlation (P < 0.001) between scores and number of previous colonoscopies (total: ρ = 0.91, GRS: ρ = 0.92, CL: ρ = 0.84), cecal intubation rate (total: ρ = 0.82, GRS: ρ = 0.85, CL: ρ = 0.77), ileal intubation rate (total: ρ = 0.82, GRS: ρ = 0.82, CL: ρ = 0.80), and physician global assessment (total: ρ = 0.95, GRS: ρ = 0.94, CL: ρ = 0.89).
The GiECATKIDS demonstrates strong reliability and validity as a measure of performance of pediatric colonoscopy that can be used to support training and assessment.
需要经过验证的评估工具来支持基于能力的教育。我们旨在评估儿科结肠镜检查胃肠道内镜能力评估工具（GiECATKIDS）的可靠性和有效性，该工具由41位北美专家采用德尔菲法开发。
GiECATKIDS包括一个7项整体评分量表（GRS）和一个18项检查表（CL）。一名主治医师对56位内镜医师在北美3家医院进行的104例结肠镜检查进行了评估，其中包括25名新手（之前操作次数<50次）、21名中级医师（50 - 250次）和10名高级内镜医师（>500次）。另一名观察者对操作进行评分，使用组内相关系数（ICC）评估评分者间信度。通过比较内镜医师第一次和第二次操作的得分，用ICC测量重测信度。通过比较经验水平与得分来检验区分效度。通过将得分与结肠镜检查经验、盲肠和回肠末端插管率以及医师整体评估进行相关性分析来评估同时效度。
GiECATKIDS的评分者间信度较高（总体：ICC = 0.88；GRS：ICC = 0.79；CL：ICC = 0.89）。重测信度极佳（总体：ICC = 0.94；GRS：ICC = 0.94；CL：ICC = 0.84）。新手、中级和高级内镜医师的GiECATKIDS总体、GRS和CL得分存在显著差异（P < 0.001）。得分与既往结肠镜检查次数（总体：ρ = 0.91，GRS：ρ = 0.92，CL：ρ = 0.84）、盲肠插管率（总体：ρ = 0.82，GRS：ρ = 0.85，CL：ρ = 0.77）、回肠插管率（总体：ρ = 0.82，GRS：ρ = 0.82，CL：ρ = 0.80）以及医师整体评估（总体：ρ = 0.95，GRS：ρ = 0.94，CL：ρ = 0.89）之间存在显著正相关（P < 0.001）。
GiECATKIDS作为一种衡量儿科结肠镜检查操作表现的工具，具有很强的可靠性和有效性，可用于支持培训和评估。
