Gastroenterology Unit, AO Ordine Mauriziano, Torino, TO, Italy.
Gastroenterology Unit, Ospedale di Bolzano, Bolzano, Italy.
J Crohns Colitis. 2017 May 1;11(5):556-561. doi: 10.1093/ecco-jcc/jjw181.
Endoscopic outcomes are increasingly used in clinical trials and in routine practice for inflammatory bowel disease [IBD] in order to reach more objective patient evaluations than possible using only clinical features. However, reproducibility of endoscopic scoring systems used to categorize endoscopic activity has been reported to be suboptimal. The aim of this study was to analyse the inter-rated agreement of non-dedicated gastroenterologists on IBD endoscopic scoring systems, and to explore the effects of a dedicated training programme on agreement.
A total of 237 physicians attended training courses on IBD endoscopic scoring systems, and they independently scored a set of IBD endoscopic videos for ulcerative colitis [with Mayo endoscopic subscore], post-operative Crohn's disease [with Rutgeerts score] and luminal Crohn's disease (with the Simple Endoscopic Score for Crohn's Disease [SESCD] and Crohn's Endoscopic Index of Severity [CDEIS]). A second round of scoring was collected after discussion about determinants of discrepancy. Interobserver agreement was measured by means of the Fleiss' kappa [kappa] or intraclass correlation coefficient [ICC] as appropriate.
The inter-rater agreement increased from kappa 0.51 (95% confidence interval [95% CI] 0.48-0.55) to 0.76 [95% CI 0.72-0.79] for the Mayo endoscopic subscore, and from 0.45 [95% CI 0.40-0.50] to 0.79 [0.74-0.83] for the Rutgeerts score before and after the training programme, respectively, and both differences were significant [P < 0.0001]. The ICC was 0.77 [95% CI 0.56-0.96] for SESCD and 0.76 [0.54- 0.96] for CDEIS, respectively, with only one measurement.
The basal inter-rater agreement of inexperienced gastroenterologists focused on IBD management is moderate; however, a dedicated training programme can significantly impact on inter-rater agreement, increasing it to levels expected among expert central reviewers.
为了实现比仅使用临床特征更客观的患者评估，内镜结果在炎症性肠病[IBD]的临床试验和常规实践中越来越多地被使用。然而，用于对内镜活动进行分类的内镜评分系统的可重复性已被报道为不理想。本研究旨在分析非专门从事胃肠病学的医生对 IBD 内镜评分系统的评分一致性，并探讨专门培训计划对一致性的影响。
共有 237 名医生参加了 IBD 内镜评分系统的培训课程，他们独立地对一组溃疡性结肠炎[梅奥内镜亚评分]、术后克罗恩病[鲁特格斯评分]和腔道克罗恩病[SESCD 和 CDEIS]的内镜视频进行评分。在讨论了差异决定因素后，收集了第二轮评分。通过 Fleiss'kappa[kappa]或适当的组内相关系数[ICC]来衡量观察者间的一致性。
观察者间的一致性从梅奥内镜亚评分的kappa 0.51（95%置信区间[95%CI]0.48-0.55）增加到 0.76（95%CI 0.72-0.79），从 Rutgeerts 评分的 kappa 0.45（95%CI 0.40-0.50）增加到 0.79（0.74-0.83），在培训计划前后，这两个差异均有统计学意义[P<0.0001]。SESCD 的 ICC 为 0.77（95%CI 0.56-0.96），CDEIS 的 ICC 为 0.76（0.54-0.96），只有一次测量。
专注于 IBD 管理的无经验胃肠病学家的基础观察者间一致性为中度；然而，专门的培训计划可以显著影响观察者间的一致性，使其提高到专家中心审查员的预期水平。
