开发结肠镜检查后出血因果归因的定义和规则。
Development of a definition and rules for causal attribution of post-colonoscopy bleeding.
机构信息
Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.
出版信息
PLoS One. 2020 Jul 23;15(7):e0235902. doi: 10.1371/journal.pone.0235902. eCollection 2020.
BACKGROUND
Post-colonoscopy bleeding (PCB) is an important colonoscopy quality indicator that is recommended to be routinely collected by colorectal cancer screening programs and endoscopy quality improvement programs. We created a standardized and reliable definition of PCB and set of rules for attributing the relatedness of PCB to a colonoscopy.
METHODS
PCB events were identified from colonoscopies performed at the Forzani & MacPhail Colon Cancer Screening Centre. Existing definitions and relatedness rules for PCB were reviewed by the authors and a draft definition and set of rules was created. The definition and rules were revised after initial testing was performed using a set of 15 bleeding events. Information available for each event included the original endoscopy report and data abstracted from the emergency or inpatient record by a trained research assistant. A validation set of 32 bleeding events were then reviewed to assess their interrater reliability by having three endoscopists and one research assistant complete independent reviews and three endoscopists complete a consensus review. The Kappa statistic was used to measure interrater reliability.
RESULTS
The panel classified 28 of 32 events as meeting the definition of PCB and rated 7, 8 and 6 events as definitely, probably and possibly related to the colonoscopy, respectively. The Kappa for the definition of PCB for the three independent reviews was 0.82 (substantial agreement). The Kappa for the attribution of the PCB to the colonoscopy by the three endosocopists was 0.74 (substantial agreement). The research assistant had a high agreement with the panel for both the definition (100% agreement) and application of the causal criteria (kappa 0.95).
CONCLUSIONS
A standardized definition of PCB and attribution rules achieved high interrater reliability by endoscopists and a non-endoscopist and provides a template of required data for event adjudication by screening and quality improvement programs.
背景
结肠镜检查后出血（PCB）是一个重要的结肠镜检查质量指标，被建议在结直肠癌筛查计划和内镜质量改进计划中常规收集。我们创建了一个标准化和可靠的 PCB 定义以及一套将 PCB 相关性归因于结肠镜检查的规则。
方法
在福扎尼和麦克菲尔结肠癌筛查中心进行的结肠镜检查中确定了 PCB 事件。作者对现有的 PCB 定义和相关性规则进行了审查，并创建了一个草案定义和规则集。在使用一组 15 个出血事件进行初步测试后，对定义和规则进行了修订。每个事件的可用信息包括原始内窥镜报告和由经过培训的研究助理从急诊或住院记录中提取的数据。然后审查了一组 32 个出血事件的验证集，通过让三位内镜医生和一位研究助理进行独立审查以及三位内镜医生进行共识审查，评估其观察者间可靠性。使用 Kappa 统计量来衡量观察者间可靠性。
结果
小组将 32 个事件中的 28 个归类为符合 PCB 定义，并分别将 7、8 和 6 个事件评为肯定、可能和可能与结肠镜检查相关。三位独立审查者对 PCB 定义的 Kappa 值为 0.82（高度一致）。三位内镜医生对 PCB 归因于结肠镜检查的 Kappa 值为 0.74（高度一致）。研究助理在定义（100%一致性）和因果标准的应用（kappa 值 0.95）方面与小组高度一致。
结论
一个标准化的 PCB 定义和归因规则通过内镜医生和非内镜医生实现了高观察者间可靠性，并为筛查和质量改进计划提供了事件裁决所需数据的模板。
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