Interobserver variation in interpreting chest radiographs for the diagnosis of acute respiratory distress syndrome
Interobserver variation in interpreting chest radiographs for the diagnosis of acute respiratory distress syndrome
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DOI：
10.1164/ajrccm.161.1.9809003
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发表时间：
2000-01-01
影响因子：
24.7
通讯作者：
Stewart, TE
中科院分区：
文献类型：
--
作者：
Meade, MO;Cook, RJ;Stewart, TE
为了衡量急性呼吸窘迫综合征（ARDS）胸部放射学诊断的可靠性，我们进行了一项观察者协议研究，其中八名重症监护医生中的两名和一名放射科医生在对彼此的解释不知情的情况下，审查了99名重症患者的778张X光照片。一名重症监护医师和一名放射科医师参加了试点培训。评分者根据弥漫性双侧浸润对ARDS的存在进行了总体评分。我们以成对的方式评估观察者间的一致性。对于其中一名评分者未参与共识过程的评分者配对，我们发现原始一致性（0.68至0.80）、机会校正一致性（kappa 0.38至0.55）和机会独立一致性（Phi 0.53至0.75）水平中等。参与共识训练的两名评分员实现了极好到几乎完美的原始（0.88到0.94），机会校正（kappa 0.72到0.88）和机会独立（Phi 0.74到0.89）一致性。我们的结论是，强化没有正式的共识培训可以实现中等水平的协议。共识训练是必要的，以达到临床试验最佳的基本或几乎完美的一致性水平。
To measure the reliability of chest radiographic diagnosis of acute respiratory distress syndrome (ARDS) we conducted an observer agreement study in which two of eight intensivists and a radiologist, blinded to one another's interpretation, reviewed 778 radiographs from 99 critically ill patients. One intensivist and a radiologist participated in pilot training. Raters made a global rating of the presence of ARDS on the basis of diffuse bilateral infiltrates. We assessed interobserver agreement in a pairwise fashion. For rater pairings in which one rater had not participated in the consensus process we found moderate levels of raw (0.68 to 0.80), chance-corrected (kappa 0.38 to 0.55), and chance-independent (Phi 0.53 to 0.75) agreement. The pair of raters who participated in consensus training achieved excellent to almost perfect raw (0.88 to 0.94), chance-corrected (kappa 0.72 to 0.88), and chance-independent (Phi 0.74 to 0.89) agreement. We conclude that intensivists without formal consensus training can achieve moderate levels of agreement. Consensus training is necessary to achieve the substantial or almost perfect levels of agreement optimal for the conduct of clinical trials.