William Harvey Research Institute, Queen Mary University of London, London, UK; Barts Health NHS Trust, London, UK.
Barts Health NHS Trust, London, UK.
Br J Anaesth. 2018 Mar;120(3):475-483. doi: 10.1016/j.bja.2017.11.071. Epub 2017 Nov 29.
Despite the increasing importance of cardiopulmonary exercise testing (CPET) for preoperative risk assessment, the reliability of CPET interpretation is unclear. We aimed to assess inter-observer reliability of preoperative CPET.
We conducted a prospective, multi-centre, observational study of preoperative CPET interpretation. Participants were professionals with previous experience or training in CPET, assessed by a standardized questionnaire. Each participant interpreted 100 tests using standardized software. The CPET variables of interest were oxygen consumption at the anaerobic threshold (AT) and peak oxygen consumption (VO peak). Inter-observer reliability was measured using intra-class correlation coefficient (ICC) with a random effects model. Results are presented as ICC with 95% confidence interval, where ICC of 1 represents perfect agreement and ICC of 0 represents no agreement.
Participants included 8/28 (28.6%) clinical physiologists, 10 (35.7%) junior doctors, and 10 (35.7%) consultant doctors. The median previous experience was 140 (inter-quartile range 55-700) CPETs. After excluding the first 10 tests (acclimatization) for each participant and missing data, the primary analysis of AT and VO peak included 2125 and 2414 tests, respectively. Inter-observer agreement for numerical values of AT [ICC 0.83 (0.75-0.90)] and VO peak [ICC 0.88 (0.84-0.92)] was good. In a post hoc analysis, inter-observer agreement for identification of the presence of a reportable AT was excellent [ICC 0.93 (0.91-0.95)] and a reportable VO peak was moderate [0.73 (0.64-0.80)].
Inter-observer reliability of interpretation of numerical values of two commonly used CPET variables was good (>80%). However, inter-observer agreement regarding the presence of a reportable value was less consistent.
尽管心肺运动测试（CPET）在术前风险评估中的重要性日益增加，但 CPET 解读的可靠性尚不清楚。我们旨在评估术前 CPET 的观察者间可靠性。
我们进行了一项前瞻性、多中心、观察性研究，评估了术前 CPET 解读的观察者间可靠性。参与者为具有 CPET 先前经验或培训的专业人员，通过标准化问卷进行评估。每位参与者使用标准化软件对 100 次测试进行解读。感兴趣的 CPET 变量包括无氧阈（AT）时的耗氧量和峰值耗氧量（VOpeak）。观察者间可靠性使用具有随机效应模型的组内相关系数（ICC）进行测量。结果以 ICC 及其 95%置信区间表示，ICC 为 1 表示完全一致，ICC 为 0 表示无一致性。
参与者包括 8/28（28.6%）临床生理学家、10（35.7%）初级医生和 10（35.7%）顾问医生。中位数的先前经验为 140（四分位距 55-700）次 CPET。排除每位参与者的前 10 次测试（适应期）和缺失数据后，对 AT 和 VOpeak 的主要分析分别包括 2125 次和 2414 次测试。AT[ICC 0.83（0.75-0.90）]和 VOpeak[ICC 0.88（0.84-0.92）]数值的观察者间一致性良好。在事后分析中，报告性 AT 存在的观察者间一致性极好[ICC 0.93（0.91-0.95）]，报告性 VOpeak 存在的一致性为中度[0.73（0.64-0.80）]。
两种常用 CPET 变量数值解读的观察者间可靠性良好（>80%）。然而，关于报告值存在的观察者间一致性不一致。
