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Inter-rater Reliability of 4-Item Arterial Doppler Waveform Classification System for Description of Arterial Doppler Waveforms.

ABSTRACT: Background: Non-invasive Doppler waveform (DW) analysis is a widely adopted method for detecting and evaluating lower extremity peripheral artery disease (PAD). Previous investigations have reported that broad heterogeneity in the description of Doppler waveforms is reduced by using a classification method. The reliability of arterial Doppler classification, however, is unknown. Purpose: The purpose of this study is to assess the reliability of a 4-category arterial DW classification method among Chinese sonographers. Methods: During a national ultrasound conference in China attendees were invited to classify thirty arterial Doppler waveforms. After viewing a 4-category (triphasic, biphasic, monophasic, and other) arterial Doppler waveform descriptor presentation, attendees were asked to classify 15 continuous wave (CW) and 15 pulsed wave (PW) Doppler waveforms. Their responses were recorded via mobile phone and the reliability of this 4-category classification was estimated by Fleiss' Kappa inter-rater statistical analysis. Results: One hundred and seventy-eight attendees participated in the analysis. The Kappa coefficient of Fleiss (?) for all attendees was 0.522 (p < 0.005) with 95% confidence interval (CI): 0.520-0.523. The reliability of the waveform descriptor triphasic was the highest (? = 0.621, p < 0.005), and other was the lowest (? = 0.341, p < 0.005). Conclusion: The inter-rater reliability of a 4-category arterial Doppler waveform classification by Chinese sonographers is considered weak (? = 0.522, CI95%: 0.520-0.523, p < 0.005). This study reinforces the importance of assessing DW classification reliability and the development of DW descriptors that are more accurately predictive of clinical hemodynamic events.

SUBMITTER: Zhao R

PROVIDER: S-EPMC7649166 | biostudies-literature | 2020

REPOSITORIES: biostudies-literature

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Inter-rater Reliability of 4-Item Arterial Doppler Waveform Classification System for Description of Arterial Doppler Waveforms.

Zhao Rui R Lanéelle Damien D Gao Meiying M Fu Yuwei Y Tong Yisha Y Scissons Robert R Wen Chaoyang C Mahé Guillaume G

Frontiers in cardiovascular medicine 20201026

<b>Background:</b> Non-invasive Doppler waveform (DW) analysis is a widely adopted method for detecting and evaluating lower extremity peripheral artery disease (PAD). Previous investigations have reported that broad heterogeneity in the description of Doppler waveforms is reduced by using a classification method. The reliability of arterial Doppler classification, however, is unknown. <b>Purpose:</b> The purpose of this study is to assess the reliability of a 4-category arterial DW classificati ...[more]

PMID: 33195470

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Project description:Background: Arterial Doppler Ultrasound waveform (DW) analysis allows the detection and evaluation of lower extremity peripheral artery disease. The high heterogeneity of the reported description of DW is reduced by the use of classification. However, the reliability of these classifications is either unknown or low to moderate and practices of vascular caregivers regarding the use of these classifications remain unknown. Aims: This study aims to assess the inter-observer reliability of the Saint-Bonnet classification, a 13-category DW classification. The secondary objective was to determine the utilization rate of the most common classifications and the ability of these classifications to describe DW. Methods: A national survey was conducted among all vascular physicians of French society of vascular medicine. They were invited by email to describe on a website 20 DW without and with the display of the Saint-Bonnet classification. The reliability of this classification was estimated by Fleiss' Kappa expressed with [95% confidence interval]. A semantic analysis allowed us to classify the physicians' responses according to the terms used. Finally we have evaluated for each classification the rate of misuse, i.e., the addition of a complementary term to the defined categories. Results: One hundred and ten physicians participated and only 5% of these were familiar with Saint-Bonnet classification. Fifty-four percent of vascular physicians used no classification at all. Vascular physicians used the Spronk (four-category), Descotes (five-category) and Saint-Bonnet (13-category) classifications for respectively, 31, 10, and 5%. Kappa coefficient of Fleiss (κ) was 0.546 [0.544-0.547] (p < 0.001). Reliability by category ranges from κ of 0.075 to 0.864. In multivariate analysis, the use of a classification was associated with fewer years of experience and was dependent on geographic location. Misuse rate by classification was 88, 82, and 5% using Spronk, Descotes and Saint-Bonnet classifications respectively. Conclusion: The reliability of Saint-Bonnet classification is weak to moderate by vascular physicians who are not familiar with its use. However, unlike the other classifications, it seems to be sufficiently precise so that the user does not need to complete its description. There is a significant heterogeneity in the use of arterial Doppler classifications in France.

Project description:Chronic cerebrospinal venous insufficiency (CCSVI) has been extremely variable, associated with multiple sclerosis in colour-Doppler sonographic studies. We aimed to evaluate inter-rater agreement in a colour-Doppler sonography venous examination.Inter-rater agreement study.First-referral multiple sclerosis centre.38 patients with multiple sclerosis and 55 age-matched (±5 years) controls.Sonography was carried out in accordance with Zamboni's five criteria by eight sonographers with different expertise, blinded to the status of cases and controls. Each participant was evaluated by two operators.Inter-rater agreement was measured through the ? statistics and the intraclass correlation coefficient.The agreement was no higher than chance for criterion 2-reflux in the deep cerebral veins (?=-0.02) and criterion 4-flow not Doppler detectable in one or both the internal jugular veins (IJVs) or vertebral veins (VVs; -0.09). It was substantially low for criterion 1-reflux in the IJVs and/or VVs (0.29), criterion 3-IJV stenosis or malformations (0.23) and criterion 5-absence of IJV diameter increase when passing from the sitting to the supine position (0.22). The ? value for CCSVI as a whole was 0.20 (95% confidence limit -0.01 to 0.42). Intraclass correlation coefficients for the measure of cross-sectional area ranged from 0.05 to 0.25. Inter-rater agreement was low for CCSVI experts (?=0.24; -0.11 to 0.59) and non-experts (0.20; -0.33 to 0.73); neurologists (0.21; -0.06 to 0.47) and non-neurologists (0.18; -0.20 to 0.56); cases (0.19; -0.14 to 0.52) and controls (0.21; -0.08 to 0.49). Zamboni-trained neurosonographers ascertained CCSVI more frequently than the non-trained neurosonographers.Agreement was unsatisfactory for the diagnosis of CCSVI as a whole, for each of its five criteria and according to the different subgroups. Standardisation of the method is urgently needed prior to its further application in studies of patients with multiple sclerosis or other neurological diseases.

Project description:Background: There has been a groundswell of national support for transparent tracking and dissemination of PhD career outcomes. In 2017, individuals from multiple institutions and professional organizations met to create the Unified Career Outcomes Taxonomy (UCOT 2017), a three-tiered taxonomy to help institutions uniformly classify career outcomes of PhD graduates. Early adopters of UCOT 2017, noted ambiguity in some categories of the career taxonomy, raising questions about its consistent application within and across institutions. Methods: To test and evaluate the consistency of UCOT 2017, we calculated inter-rater reliability across two rounds of iterative refinement of the career taxonomy, classifying over 800 PhD alumni records via nine coders. Results: We identified areas of discordance in the taxonomy, and progressively refined UCOT 2017 and an accompanying Guidance Document to improve inter-rater reliability across all three tiers of the career taxonomy. However, differing interpretations of the classifications, especially for faculty classifications in the third tier, resulted in continued discordance among the coders. We addressed this discordance with clarifying language in the Guidance Document, and proposed the addition of a flag system for identification of the title, rank, and prefix of faculty members. This labeling system provides the additional benefit of highlighting the granularity and the intersectionality of faculty job functions, while maintaining the ability to sort by - and report data on - faculty and postdoctoral trainee roles, as is required by some national and federal reporting guidelines. We provide specific crosswalk guidance for how a user may choose to incorporate our suggestions while maintaining the ability to report in accordance with UCOT 2017. Conclusions: Our findings underscore the importance of detailed guidance documents, coder training, and periodic collaborative review of career outcomes taxonomies as PhD careers evolve in the global workforce. Implications for coder-training and use of novice coders are also discussed.

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Inter-rater Reliability of 4-Item Arterial Doppler Waveform Classification System for Description of Arterial Doppler Waveforms.

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Inter-rater Reliability of 4-Item Arterial Doppler Waveform Classification System for Description of Arterial Doppler Waveforms.

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