Miquel Laura, Agostini Aubert, Loundou Anderson, Daoud Salima, Mazza Elisabetta, Munro Malcolm G, Crochet Patrice
Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France (Drs. Miquel and Agostini); CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Support Unit for Clinical Research and Health Economics, AP-HM, Marseille, France (Dr. Loundou); Monitoring Force Group, Cedex, France (Dr. Daoud); Università degli studi di Milano, Milan, Italy (Dr. Mazza); University of California, Los Angeles, Los Angeles, California (Dr. Munro); Department of Gynecology and Obstetrics, CHU Rouen, Rouen, France (Dr. Crochet).
Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France (Drs. Miquel and Agostini); CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Support Unit for Clinical Research and Health Economics, AP-HM, Marseille, France (Dr. Loundou); Monitoring Force Group, Cedex, France (Dr. Daoud); Università degli studi di Milano, Milan, Italy (Dr. Mazza); University of California, Los Angeles, Los Angeles, California (Dr. Munro); Department of Gynecology and Obstetrics, CHU Rouen, Rouen, France (Dr. Crochet).
J Minim Invasive Gynecol. 2025 Jun;32(6):512-519.e1. doi: 10.1016/j.jmig.2024.12.016. Epub 2024 Dec 30.
To study the inter-rater reliability of an electronic complementary uterine diagram (electronic American Fertility Society [eAFS] freely available at https://bit.ly/eAFS-score) in comparison with the conventional American Fertility Society (cAFS) intrauterine adhesion (IUA) scoring system. As a secondary aim, we wanted to assess the intra-rater reliability of these tools.
This was an observational cross-over study with a nested test-retest design.
Self-identified gynecologists who performed diagnostic hysteroscopy as part of their routine practice were asked to score IUA on 7 preselected videos using both cAFS and eAFS tools in 2 separate rounds. The order of use of tools was determined at random. Gynecologists who agreed to be involved in a third round were asked to use the tool they were allocated to in the first round to assess intra-rater variability.
No patients were recruited for the purpose of this study.
Inter-rater agreement between evaluators when using eAFS and cAFS for IUA scoring. Overall, the inter-rater agreement was fair (0.25; confidence interval [CI], 0.17-0.34) for cAFS and moderate (0.53; CI, 0.48-0.58) for the eAFS tool. The biggest difference between both tools was seen in the "extent of cavity involved" component, which was fair (0.28; CI, 0.21-0.35) vs substantial (0.71; CI, 0.64-0.78) for cAFS vs eAFS, respectively. Moreover, agreement coefficients were comparable among "expert" and "non-expert" evaluators with the use of the eAFS tool. In addition, intra-rater perfect agreement was higher with the use of eAFS than cAFS (38% vs 32.5%).
The current AFS IUA scoring system has fair inter-rater agreement. However, using a complementary electronic uterine diagram increased this agreement from fair to moderate overall and from fair to substantial in the "extent of adhesions" domain of the tool. The use of the electronic diagram also improved inter-rater agreement among non-experts making it comparable with that of experts.
比较电子辅助子宫图（可在https://bit.ly/eAFS-score免费获取的电子美国生育协会[eAFS]）与传统美国生育协会（cAFS）子宫内粘连（IUA）评分系统之间的评分者间信度。作为次要目的，我们想评估这些工具的评分者内信度。
这是一项采用嵌套重测设计的观察性交叉研究。
邀请将诊断性宫腔镜检查作为日常工作一部分的妇科医生，在两轮独立的评分中，使用cAFS和eAFS工具对7个预先选定的视频中的IUA进行评分。工具的使用顺序随机确定。同意参与第三轮评分的妇科医生被要求使用他们在第一轮中分配到的工具来评估评分者内变异性。
本研究未招募患者。
评估者在使用eAFS和cAFS对IUA进行评分时的评分者间一致性。总体而言，cAFS的评分者间一致性为中等（0.25；置信区间[CI]，0.17 - 0.34），eAFS工具的评分者间一致性为中等（0.53；CI，0.48 - 0.58）。两种工具之间最大的差异体现在“宫腔受累程度”部分，cAFS为中等（0.28；CI，0.21 - 0.35），而eAFS为高度一致（0.71；CI，0.64 - 0.78）。此外，在使用eAFS工具时，“专家”和“非专家”评估者之间的一致性系数相当。另外，使用eAFS时评分者内完全一致性高于cAFS（38%对32.5%）。
当前的AFS IUA评分系统具有中等评分者间一致性。然而，使用辅助电子子宫图使总体一致性从中等提高到中等，并且在工具的“粘连程度”领域从中等提高到高度一致。使用电子图还提高了非专家之间的评分者间一致性，使其与专家相当。
