Royal Veterinary College, Hatfield, Hertfordshire, UK.
Equine Vet J. 2021 May;53(3):495-502. doi: 10.1111/evj.13334. Epub 2020 Sep 17.
Equine glandular gastric disease (EGGD) is recognised as a separate entity to equine squamous gastric disease (ESGD) and it is recommended that lesions are graded differently. Currently, no validated scoring system exists for EGGD.
To determine inter-observer reliability of two previously described grading systems for EGGD and to assess if agreement improved with gastroscopy experience, specialist training or familiarity with the descriptive system.
Cross-sectional survey.
A link to an electronic questionnaire containing 20 images of glandular lesions was circulated. Respondents were asked to score lesions using descriptive terminology and a 0-2 verbal rating scale (VRS). Krippendorff's alpha reliability estimate was used to assess inter-rater agreement. A mixed effects model was used to determine which descriptive categories were associated with lesions being described as severe and decision to treat.
Eighty-two veterinarians responded, 49 diplomates and 33 non-diplomates. There was no agreement when all four descriptive variables were combined (α = 0.19). Agreement was fair to moderate for severity (α = 0.52), distribution (α = 0.44), appearance (α = 0.38) and shape (α = 0.32). Agreement for the VRS was similar to that for severity (α = 0.53). Agreement was better among diplomates across all categories. Lesion appearance and shape, but not distribution, were associated with both a decision to treat; and lesions being described as severe (P =< .05). A VRS score 2/2 was associated with a lesion being described as severe (OR 75.2, 95% CI 51.12-110.48, P =< .001).
Intra-observer variability was not assessed. The number of images is relatively small, and the decision to treat is based on several factors in practice.
Overall, agreement for the descriptive system was poor. Better delineation of descriptive category boundaries and characteristics should be determined. Agreement was similar when comparing the severity category and the VRS. Extrapolation to a VRS based on lesion severity may therefore be possible.
马腺胃疾病（EGGD）被认为是一种独立于马食管胃疾病（ESGD）的疾病，建议对其病变进行不同的分级。目前，尚无针对 EGGD 的验证评分系统。
确定两种先前描述的 EGGD 分级系统的观察者间可靠性，并评估如果增加胃镜检查经验、专业培训或对描述性系统的熟悉程度是否可以提高一致性。
横断面调查。
向参与者发送了一个包含 20 个腺胃病变图像的电子问卷链接。要求受访者使用描述性术语和 0-2 级口头评分量表（VRS）对病变进行评分。使用 Krippendorff 的 alpha 可靠性估计来评估观察者间的一致性。使用混合效应模型确定哪些描述性类别与病变被描述为严重和治疗决策相关。
共有 82 名兽医做出了回应，其中 49 名是专科兽医，33 名是非专科兽医。当结合所有四个描述性变量时，没有达成一致（α=0.19）。严重程度（α=0.52）、分布（α=0.44）、外观（α=0.38）和形状（α=0.32）的一致性为中等至良好。VRS 的一致性与严重程度相似（α=0.53）。在所有类别中，专科兽医的一致性都更好。病变外观和形状，但不是分布，与治疗决策以及病变被描述为严重有关（P<0.05）。VRS 评分为 2/2 与病变被描述为严重相关（OR 75.2，95%CI 51.12-110.48，P<0.001）。
未评估观察者内变异性。图像数量相对较少，并且在实践中，治疗决策基于多个因素。
总体而言，描述性系统的一致性较差。应该确定描述性类别边界和特征的更好划分。比较严重程度类别和 VRS 时，一致性相似。因此，可能可以根据病变严重程度推断出基于 VRS 的评分。
