Myers K A, Scott D F, Devine T J, Johnston A H, Denton M J, Gilfillan I S
Department of Vascular Surgery, Prince Henry's Hospital, Melbourne, Australia.
Eur J Vasc Surg. 1987 Aug;1(4):245-9. doi: 10.1016/s0950-821x(87)80075-0.
Six vascular surgeons independently examined 44 legs in patients with suspected peripheral arterial disease. Each surgeon recorded whether the femoral and popliteal pulses were present or absent, and if thought to be present, whether they were normal or reduced in amplitude. Interobserver agreement was determined by calculating both observed agreement (Po) and agreement after correction for chance (kappa-k). The results were calculated both for each possible pair of surgeons and as an overall value for all possible pairs combined. Agreement as to whether pulses were present or absent was significantly better than expected by chance but was only moderately good (overall kappa for femoral pulse = 0.53, and overall kappa for popliteal pulse = 0.52). More often than not, agreement as to whether the pulses were normal or reduced was no better than expected by chance (overall kappa for femoral pulse = 0.15, and overall kappa for popliteal pulse = 0.01). For each assessment, agreement was no better for the more experienced than the less experienced pairs of surgeons. The results indicate that more objective methods than pulse palpation are required to determine whether there is significant disease in the aorto-iliac and femoro-popliteal arterial segments.
六位血管外科医生对44例疑似外周动脉疾病患者的腿部进行了独立检查。每位医生记录股动脉和腘动脉搏动是否存在，若认为存在，则记录其幅度是正常还是减弱。通过计算观察一致性（Po）和校正机遇后的一致性（kappa-k）来确定观察者间的一致性。结果分别针对每对可能的医生进行计算，并作为所有可能组合的总体值计算。对于搏动是否存在的一致性明显优于机遇预期，但仅为中等程度的良好（股动脉总体kappa值 = 0.53，腘动脉总体kappa值 = 0.52）。对于搏动幅度是正常还是减弱的一致性，通常并不比机遇预期更好（股动脉总体kappa值 = 0.15，腘动脉总体kappa值 = 0.01）。对于每次评估，经验更丰富的医生对与经验较少的医生对之间的一致性并无差异。结果表明，需要比脉搏触诊更客观的方法来确定腹主动脉-髂动脉和股动脉-腘动脉段是否存在显著疾病。
