Imamura K, McKinnon M, Middleton R, Black N
Dept. of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK.
J Clin Epidemiol. 1997 Sep;50(9):1011-6. doi: 10.1016/s0895-4356(97)00128-5.
The reliability of an established comorbidity index (the Index of Co-Existent Disease) was tested using retrospective data from the case notes of elderly patients who had undergone total hip replacement. Inter-rater reliability was examined twice, first with two raters (n = 39) and then with three (n = 49). Intra-rater reliability was assessed using one rater (n = 45). Reasons for any lack of reliability were explored. The inter-rater reliability of the ICED was moderate (kappa 0.5-0.6). While the Functional Severity index performed well (kappa 0.6-1.0), the Index of Disease Severity subindex was less reliable (kappa 0.4-0.5). Differences between raters had an impact on the observed association between comorbidity and serious post-operative complications. Intra-rater reliability was excellent (kappa 0.9). Several reasons why inter-rater reliability was only moderate were identified, mostly related to uncertainties in applying the ICED. The reliability of the ICED needs to be improved before it is used more widely with retrospective data. This might be achieved by further clarification of the instructions for its use.
利用接受全髋关节置换术的老年患者病历中的回顾性数据，对一种既定的共病指数（共存疾病指数）的可靠性进行了测试。对评估者间信度进行了两次检验，第一次由两名评估者（n = 39）进行，第二次由三名评估者（n = 49）进行。评估者内信度由一名评估者（n = 45）进行评估。探讨了信度不足的原因。共存疾病指数的评估者间信度为中等（kappa值0.5 - 0.6）。虽然功能严重程度指数表现良好（kappa值0.6 - 1.0），但疾病严重程度子指数的信度较低（kappa值0.4 - 0.5）。评估者之间的差异对观察到的共病与严重术后并发症之间的关联有影响。评估者内信度极佳（kappa值0.9）。确定了评估者间信度仅为中等的几个原因，大多与应用共存疾病指数时的不确定性有关。在更广泛地将共存疾病指数用于回顾性数据之前，其信度需要提高。这可以通过进一步明确其使用说明来实现。
