Hart Lara, Chavannes Mallory, Lakatos Peter L, Afif Waqqas, Bitton Alain, Bressler Brian, Bessissow Talat
Division of Gastroenterology, McGill University Health Center, Montreal, Quebec, Canada.
Division of Gastroenterology, University of British Columbia, Vancouver, British Columbia, Canada.
J Can Assoc Gastroenterol. 2020 Oct;3(5):216-221. doi: 10.1093/jcag/gwz022. Epub 2019 Jun 19.
Gastroenterologists should accurately describe endoscopic findings and integrate them into management plans. We aimed to determine if trainees and staff are describing inflammatory bowel disease (IBD) lesions in a similar manner.
Using 20 ileocolonoscopy images, participants described IBD inflammatory burden based on physician severity rating, and Mayo endoscopic score (MES) (ulcerative colitis [UC]) or simple endoscopic score (SES-CD) (Crohn's disease [CD]). Images were selected based on agreement by three IBD experts. Findings of varying severity were presented; 10 images included a question about management. We examined inter-observer agreement among trainees and staff, compared trainees to staff, and determined accuracy of response comparing both groups to IBD experts.
One hundred and twenty-nine staff and 47 trainees participated from across Canada. There was moderate inter-rater agreement using physician severity rating (κ = 0.53 UC and 0.52 CD for staff, κ = 0.51 UC and 0.43 CD for trainees). There was moderate inter-rater agreement for MES for staff and trainees (κ = 0.49 and 0.48, respectively), but fair agreement for SES-CD (κ = 0.37 and 0.32, respectively). For accuracy of response, the mean score was 68.7% for staff and 63.7% for trainees ( = 0.028). Both groups identified healed bowel or severe disease better than mild/moderate ( < 0.05). There was high accuracy for management, but staff scored higher than trainees for UC ( < 0.01).
Inter-rater agreement on description of IBD lesions was moderate at best. Staff and trainees more accurately describe healed and severe disease, and better describe lesions in UC than CD.
胃肠病学家应准确描述内镜检查结果并将其纳入管理计划。我们旨在确定实习生和工作人员对炎症性肠病（IBD）病变的描述方式是否相似。
使用20张回结肠镜检查图像，参与者根据医生严重程度评分、梅奥内镜评分（MES）（溃疡性结肠炎[UC]）或简单内镜评分（SES-CD）（克罗恩病[CD]）描述IBD炎症负担。图像是根据三位IBD专家的共识选择的。呈现了不同严重程度的检查结果；10张图像包含了关于管理的问题。我们检查了实习生和工作人员之间的观察者间一致性，将实习生与工作人员进行比较，并通过将两组与IBD专家进行比较来确定回答的准确性。
来自加拿大各地的129名工作人员和47名实习生参与了研究。使用医生严重程度评分时，评分者间一致性为中等（工作人员的UC为κ = 0.53，CD为κ = 0.52；实习生的UC为κ = 0.51，CD为κ = 0.43）。工作人员和实习生对MES的评分者间一致性为中等（分别为κ = 0.49和0.48），但对SES-CD的一致性为一般（分别为κ = 0.37和0.32）。对于回答的准确性，工作人员的平均得分为68.7%，实习生为63.7%（P = 0.028）。两组对愈合的肠道或严重疾病的识别都优于轻度/中度疾病（P < 0.05）。在管理方面准确性较高，但在UC方面工作人员的得分高于实习生（P < 0.01）。
对IBD病变描述方面的评分者间一致性充其量为中等。工作人员和实习生能更准确地描述愈合和严重疾病，且对UC病变的描述比对CD病变的描述更好。
