Prospective multicenter assessment of interobserver agreement for radiologist interpretation of multidetector computerized tomographic angiography for pulmonary embolism
Prospective multicenter assessment of interobserver agreement for radiologist interpretation of multidetector computerized tomographic angiography for pulmonary embolism
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DOI：
10.1111/j.1538-7836.2009.03724.x
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发表时间：
2010-03-01
影响因子：
10.4
通讯作者：
Kline, J. A.
中科院分区：
文献类型：
--
作者：
Courtney, D. M.;Miller, C.;Kline, J. A.
背景资料：急诊医生依靠放射科医生的解释来诊断和排除肺栓塞（PE）的基础上，计算机断层肺血管造影（CTPA）。关于该终点的观察者间可靠性的数据很少。目的：量化四家学术医院和一家独立参考阅读（IRR）实验室之间CTPA解读的一致程度。研究方法：从四家学术医院入组了具有一种预定义PE症状和体征并接受64层CTPA的住院和急诊患者。由医院认证的放射科医生解释的CTPA结果与IRR实验室的结果进行了比较。CTPA被解读为不确定，PE-或PE+，梗阻百分比由IRR实验室使用已发表的方法计算。采用加权Cohen's kappa计算一致性。结果：我们入组了492例受试者（63%为女性，年龄54 ± 1岁，16.7%为研究中心医院的PE+）。总体一致率为429/492（87.2%; 95%置信区间83.9-90.0）。我们观察到13例（2.6%）完全不一致，其中一个阅读为PE+，另一个阅读为PE-。加权一致率为92.3%，kappa = 0.75。所有患者的梗阻百分比中位数为9%（第25 - 75百分位数四分位数间距：5%至-30%）。对于在研究中心医院解释为PE-或不确定但由IRR实验室解读为PE+的CTPA，梗阻百分比的中位数为6%（4-7%）。结论：我们发现该样本的一致性水平良好，加权Kappa值为0.75，但2.6%的患者完全不一致。总体而言，大部分凝块为远端或轻度闭塞性凝块。
Background: Emergency physicians rely on the interpretation of radiologists to diagnose and exclude pulmonary embolism (PE) on the basis of computerized tomographic pulmonary angiography (CTPA). Few data exist regarding the interobserver reliability of this endpoint. Objective: To quantify the degree of agreement in CTPA interpretation between four academic hospitals and an independent reference reading (IRR) laboratory. Methods: Hospitalized and emergency department patients who had one predefined symptom and sign of PE and underwent 64-slice CTPA were enrolled from four academic hospitals. CTPA results as interpreted by board-certified radiologists from the hospitals were compared against those from the IRR laboratory. CTPAs were read as indeterminate, PE- or PE+, and percentage obstruction was computed by the IRR laboratory, using a published method. Agreement was calculated with weighted Cohen's kappa. Results: We enrolled 492 subjects (63% female, age 54 +/- 1 years, and 16.7% PE+ at the site hospitals). Overall agreement was 429/492 (87.2%; 95% confidence interval 83.9-90.0). We observed 13 cases (2.6%) of complete discordance, where one reading was PE+ and the other reading was PE-. Weighted agreement was 92.3%, with kappa = 0.75. The median percentage obstruction for all patients was 9% (25th-75th percentile interquartile range: 5% to - 30%). For CTPAs interpreted at the site hospitals as PE- or indeterminate but read as PE+ by the IRR laboratory, the median of percentage obstruction was 6% (4-7%). Conclusion: We found in this sample a good level of agreement, with a weighted kappa of 0.75, but with 2.6% of patients having total discordance. Overall, a large proportion of clots were distal or minimally occlusive clots.