Reliability between two observers using a protocol for diagnosing essential tremor
Reliability between two observers using a protocol for diagnosing essential tremor
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DOI：
10.1002/mds.870130215
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发表时间：
1998-03-01
影响因子：
8.6
通讯作者：
Bismuth, B
中科院分区：
文献类型：
--
作者：
Louis, ED;Ford, B;Bismuth, B
已经建立了许多运动障碍的诊断与证明的可靠性协议，而在特发性震颤（ET）的文献中，没有关于诊断协议的可靠性的讨论。缺乏对ET诊断协议可靠性的了解限制了这些协议的使用，因为可靠性是数据管理科学质量的基本要求。本研究的目的是确定诊断ET的方案的可靠性。该协议包括震颤访谈，录像震颤检查和诊断算法。在华盛顿Heights-Inwood，纽约的一项基于社区的健康研究中确定的83名ET受试者与来自同一社区的83名对照受试者相匹配。这些受试者及其亲属被招募参加华盛顿Heights-Inwood ET遗传研究。到目前为止，已对226例受试者进行了评估（35例ET病例，40例对照，151例亲属）。所有226人进行了84项震颤访谈和26项震颤检查录像。诊断（正常，可能的ET，很可能的ET，明确的ET）由两名专门研究运动障碍的盲态神经学家独立分配。kappa统计量k用于确定这两位神经科医生之间的诊断一致性。两名评估者使用明确ET、可能ET、可能ET和正常诊断类别的一致率为80%; k（w）= 0.84（接近完美至完美一致）。两名评定者使用两种诊断类别（明确的ET和正常）的一致率为100%，k = 1.00（完全一致），两名评定者的震颤总分之间有高度相关性（r = 0.89，p < 0.00001）。该诊断方案是高度可靠的。ET的研究将大大受益于已证明可靠性的诊断协议。
Protocols with demonstrated reliability have been established for the diagnosis of numerous movement disorders, whereas in the essential tremor (ET) literature, there is no discussion about the reliability of diagnostic protocols. Lack of knowledge of the reliability of diagnostic protocols in ET limits the use of these protocols because reliability is an essential requirement for scientific quality in data management. The ob objective of this study was to determine the reliability of a protocol for diagnosing ET. The protocol consists of a Tremor Interview, a videotaped Tremor Examination, and a diagnostic algorithm. Eighty-three subjects with ET, identified in a community-based health study in Washington Heights-Inwood, New York, were matched with 83 control subjects from the same community. These subjects and their relatives are being recruited to participate in the Washington Heights-Inwood Genetic Study of ET. Two hundred twenty-six subjects have been evaluated to date (35 ET cases, 40 controls, 151 relatives). All 226 underwent an 84-item Tremor interview and 26-item videotaped Tremor Examination. Diagnoses (normal, possible ET, probable ET, definite ET) were independently assigned by two blinded neurologists specializing in movement disorders. The kappa statistic, k, was used to determine diagnostic agreement between these two neurologists. The concordance rate between two raters using diagnostic categories definite ET, probable ET, possible ET, and normal was 80%; k(w) = 0.84 (near perfect to perfect agreement). The concordance rate between two raters using two diagnostic categories (definite ET and normal) was 100%; k = 1.00 (perfect agreement), There was high correlation between the two raters' total tremor scores (r = 0.89, p < 0.00001). This diagnostic protocol is highly reliable. Research in ET would greatly benefit from diagnostic protocols with demonstrated reliability.