Christian B, Amezdroz E, Calache H, Gussy M, Sore R, Waters E
Evidence and Child Health, The University of Melbourne.
Centre for Population Health Research, Deakin University.
Community Dent Health. 2017 Dec 1;34(4):248-253. doi: 10.1922/CDH_4102Christian06.
to compare two methods of in vitro examiner calibration in populations and settings where clinical (in vivo) calibration is not practical.
Study design was cross-sectional and fully-crossed. The units of analysis were 880 tooth surfaces, from ten children ages 3 to 4 years. The study had three data components: (1) Examiner training and calibration using the International Caries Detection and Assessment System (ICDAS) e-Learning programme (2) In vivo community-based visual examination and (3) Intra-oral digital photographs of the same tooth surfaces from the in vivo visual examination. Kappa and weighted kappa scores were used to study reliability estimates. Systematic differences in caries assessments were determined using the Stuart Maxwell test. Data were analysed using STATA 13.1 and SAS 9.2.
Weighted kappa scores for the in vivo component ranged from 0.50 to 0.66 and from 0.64-0.74, for inter- and intraexaminer reliability, respectively. Caries lesions detected in vivo were also detected on photographs, albeit with more false positives when using photographs. For example, of 46 tooth surfaces assessed as being sound in the in vivo examination, 22 (48%) of these were assessed as having caries when photographs were used as the diagnostic method.
From this research it appears that good quality photographs alone may be used for training and calibration among challenging populations or settings without adversely affecting data quality.
在临床（体内）校准不实用的人群和环境中，比较两种体外检查者校准方法。
研究设计为横断面且完全交叉。分析单位是来自10名3至4岁儿童的880个牙面。该研究有三个数据组成部分：（1）使用国际龋病检测与评估系统（ICDAS）电子学习程序对检查者进行培训和校准；（2）基于社区的体内视觉检查；（3）体内视觉检查中相同牙面的口腔内数码照片。使用kappa和加权kappa分数来研究可靠性估计。使用斯图尔特·麦克斯韦检验确定龋病评估中的系统差异。数据使用STATA 13.1和SAS 9.2进行分析。
体内部分的加权kappa分数，检查者间可靠性范围为0.50至0.66，检查者内可靠性范围为0.64至0.74。体内检测到的龋损在照片上也能检测到，不过使用照片时假阳性更多。例如，在体内检查中被评估为健康的46个牙面中，当使用照片作为诊断方法时，其中22个（48%）被评估为有龋病。
从这项研究来看，在具有挑战性的人群或环境中，仅高质量照片可用于培训和校准，且不会对数据质量产生不利影响。
