Pediatric Gastroenterology Hepatology and Transplantation.
FROM Research Foundation, ASST Papa Giovanni XXIII, Bergamo.
J Pediatr Gastroenterol Nutr. 2021 Jul 1;73(1):48-53. doi: 10.1097/MPG.0000000000003090.
There is a large interobserver variability in evaluating mucosal lesions of inflammatory bowel disease (IBD), especially in pediatric patients. This multicenter prospective observational study aims to evaluate interobserver agreement (IOA) among pediatric endoscopists in assigning validated IBD endoscopic scores in children.
Fifteen videos of follow-up ileocolonoscopies in children with IBD were recorded and selected as cases. Eleven pediatric endoscopists from different centers blindly evaluated all videos and calculated scores: either Ulcerative Colitis Endoscopic Index of Severity (UCEIS) or Simple Endoscopic Score for Crohn Disease (SES-CD). Scores from all reviewers were compared in order to calculate IOA for general videos and specific sections. Scores from an expert adult reader were used to calculate possible reviewer's characteristics affecting scores' reliability.
Intraclass correlation was 0.298 (95% confidence interval [CI]: 0.13-0.55) for ulcerative colitis (UC) and 0.266 (0.11-0.52) for Crohn disease (CD). When a disease activity categorization was adopted (remission, mild, moderate, severe activity) Fleiss kappa coefficient was 0.408 (0.29-0.53) for UC and 0.552 (0.43-0.73) for CD. When stratified by item, vascular pattern of UC was the most reliable item IC: 0.624 (0.321-0.854). In multivariable analysis, none of the reviewer's characteristics affected the readers' errors.
This multicenter study shows low agreement among pediatric endoscopists in evaluating endoscopic scores in children with IBD. By using disease activity categorization, agreement slightly increased, mostly for CD. All readers showed a low-grade concordance with the expert adult gastroenterologist's evaluations. Future-specific training programs should be considered to increase IOA in using IBD endoscopic activity scores.
评估炎症性肠病（IBD）的黏膜病变存在很大的观察者间变异性，尤其是在儿科患者中。这项多中心前瞻性观察研究旨在评估儿科内镜医师在为儿童分配经过验证的 IBD 内镜评分时的观察者间一致性（IOA）。
记录并选择了 15 例儿童 IBD 随访回肠结肠镜检查的视频作为病例。来自不同中心的 11 名儿科内镜医师对所有视频进行了盲法评估，并计算了评分：溃疡性结肠炎内镜严重程度指数（UCEIS）或简单克罗恩病内镜评分（SES-CD）。为了计算一般视频和特定部分的 IOA，比较了所有审阅者的评分。专家成人读者的评分用于计算可能影响评分可靠性的审阅者特征。
溃疡性结肠炎（UC）的组内相关系数为 0.298（95%置信区间 [CI]：0.13-0.55），克罗恩病（CD）为 0.266（0.11-0.52）。当采用疾病活动分类（缓解、轻度、中度、重度活动）时，UC 的Fleiss κ系数为 0.408（0.29-0.53），CD 为 0.552（0.43-0.73）。按项目分层时，UC 的血管模式是最可靠的项目 IC：0.624（0.321-0.854）。多变量分析显示，审阅者的任何特征均未影响读者的错误。
这项多中心研究表明，儿科内镜医师在评估儿童 IBD 的内镜评分方面存在较低的一致性。通过使用疾病活动分类，一致性略有增加，主要针对 CD。所有读者与专家成人胃肠病学家的评估均显示出低度一致性。应考虑未来的特定培训计划，以提高使用 IBD 内镜活动评分的 IOA。
