Section of Periodontics, Department of Oral and Maxillofacial Sciences, Sapienza University of Rome, Rome, Italy.
Division of Periodontology and Implant Dentistry, Faculty of Dentistry, the University of Hong Kong, Hong Kong, China.
J Clin Periodontol. 2021 Feb;48(2):205-215. doi: 10.1111/jcpe.13406. Epub 2020 Dec 14.
The objective of this study was to evaluate consistency and accuracy of the periodontitis staging and grading classification system.
Thirty participants (10 periodontal experts, 10 general dentists and 10 undergraduate students) and a gold-standard examiner were asked to classify 25 fully documented periodontitis cases twice. Fleiss kappa was used to estimate consistency across examiners. Intraclass correlation coefficient (ICC) was used to calculate consistency across time. Quadratic weighted kappa and percentage of complete agreement versus gold standard were computed to assess accuracy.
Fleiss kappa for stage, extent and grade were 0.48, 0.37 and 0.45 respectively. The highest ICC was provided by students for stage (0.91), whereas the lowest ICC by general dentists for extent (0.79). Pairwise comparisons against gold standard showed mean value of kappa >0.81 for stage and >0.41 for grade and extent. Agreement with the gold standard for all three components of the case definition was achieved in 47.2% of cases. The study identified specific factors associated with lower consistency and accuracy.
Diagnosis was highly consistent across time and moderately between examiners. Accuracy was almost perfect for stage and moderate for grade and extent. Additional efforts are required to improve training of general dentists.
本研究旨在评估牙周炎分期和分级分类系统的一致性和准确性。
30 名参与者（10 名牙周病专家、10 名普通牙医和 10 名本科生）和一名金标准检查者被要求对 25 例充分记录的牙周炎病例进行两次分类。Fleiss kappa 用于评估检查者之间的一致性。组内相关系数（ICC）用于计算随时间的一致性。二次加权 kappa 和与金标准的完全一致百分比用于评估准确性。
阶段、程度和等级的 Fleiss kappa 分别为 0.48、0.37 和 0.45。学生对阶段的 ICC 最高（0.91），而普通牙医对程度的 ICC 最低（0.79）。与金标准的两两比较显示，阶段的 kapp 值平均值>0.81，等级和程度的 kapp 值平均值>0.41。在所有三个病例定义组成部分中，与金标准一致的病例达到 47.2%。研究确定了与较低一致性和准确性相关的特定因素。
诊断在时间上高度一致，在检查者之间中度一致。阶段的准确性近乎完美，等级和程度的准确性适中。需要进一步努力提高普通牙医的培训。
