Development of appropriateness criteria for colonoscopy: comparison between a standardized expert panel and an evidence-based medicine approach
Development of appropriateness criteria for colonoscopy: comparison between a standardized expert panel and an evidence-based medicine approach
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DOI：
10.1093/intqhc/15.1.15
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发表时间：
2003-02-01
影响因子：
2.6
通讯作者：
Burnand, B
中科院分区：
文献类型：
--
作者：
Nicollier-Fahrni, A;Vader, JP;Burnand, B
目标。评估由标准化专家小组方法制定的结肠镜检查的适当性标准与已发表的研究证据之间的一致性程度。描述性、协议性研究。设置。多学科小组；瑞士的初级保健实践。参与者。9名国家专家；577名转诊为结肠镜检查的初级保健患者；154篇发表的论文。基于对文献的全面回顾，评估402种可能的结肠镜检查临床适应症的适宜性。主要结果指标。符合比例(加权kappa)，小组和文献为基础的适宜性类别(适当的，不确定的，不适当的)之间遇到的理论和实际适应症。专家小组评定的402个适应症中，有19个可能是基于从8个随机临床试验中检索到的证据。在专家组标准和基于研究的标准之间发现了68%的一致性(kappa=0.52)。增加了一项非对照试验和七项观察性研究，得到了71%的一致性(kappa=0.63)。在检查577个实际案例时，一致性相似：69%的一致性，kappa=0.47。基于专家小组的适应症和已发表证据之间的一致性不受已发表报告的全面性和表观质量的影响。大多数结肠镜检查适应症的适当性的证据不能直接从已发表的文献中获得。专家小组制定的适当性标准与已发表研究的证据之间的一致性在可能的情况下是中等到良好的。应寻求新的办法，以便系统地将从临床试验和专家小组获得的补充证据纳入实践指南。
Objectives. To assess the degree of agreement between appropriateness criteria for the use of colonoscopy developed by a standardized expert panel method and evidence from published studies.Design. Descriptive, agreement study.Setting. Multidisciplinary panel; primary care practice in Switzerland.Participants. Nine national experts; 577 primary care patients referred for colonoscopy; 154 published papers.Interventions. Evaluation of the appropriateness of 402 possible clinical indications for colonoscopy, based on a comprehensive review of the literature.Main outcomes measures. Proportion of agreement (weighted kappa), between panel- and literature-based appropriateness categories (appropriate, uncertain, inappropriate) for theoretical and actual indications encountered.Results. Nineteen of 402 indications rated by the panel could be based on the evidence retrieved from eight randomized clinical trials. A 68% agreement (kappa = 0.52) was found between panel- and study-based criteria. The addition of an uncontrolled trial and seven observational studies yielded a 71% agreement (kappa = 0.63). Agreement was similar when examining 577 actual cases: 69% agreement, kappa = 0.47. Agreement between panel-based indications and published evidence was not influenced by the perceived comprehensiveness and the apparent quality of the published reports.Conclusions. Evidence for the appropriateness of most indications for colonoscopy could not be derived directly from the published literature. Agreement between appropriateness criteria developed by an expert panel and evidence from published studies was moderate to good, where available. New approaches should be sought in order to systematically integrate complementary evidence obtained from clinical trials and expert panels into practice guidelines.