DAP肾肿瘤评分系统的可信度和可重复性研究

Intra-observer and inter-observer reliability of the diameter-axial-polar nephrometry score

目的评估DAP肾肿瘤评分系统的可信度和可重复性。方法收集2013年至2015年于我院行肾部分切除术的110例患者的影像学资料,由5名泌尿外科医师(2名主治医师和3名住院医师)采用DAP系统独立进行评分,其中2名住院医师间隔3个月后再次进行评分,分别应用Kappa和Kendall tau-b分析法评估同一评分者和2名评分者间DAP各参数及总分的一致性,ICC检验分析不同资历医师的一致性。结果同一评分者DAP各参数及总分的Kappa值分别为0.889、0.817、0.787、0.693和0.897、0.834、0.830、0.708。2名评分者之间DAP各参数及总分的Kendall tau-b值分别为0.896、0.832、0.847、0.832。Bland-Altman图显示,D、A、P参数均有超过90%的位点在95%的置信区间的参考线内。高年资医师间评分的一致性较低年资医师高。结论 DAP肾肿瘤评分系统在同一评分者及不同评分者间的一致性好,具有良好的可信度和可重复性。

Objective To evaluate the intra-observer and inter-observer reliability of diameter- axial-polar nephrometry score. Methods The imaging data of 110 patients who underwent partial nephrectomy in our hospital were collected and independently scored by 5 urologists （2 attendings and 3 residents）. The two residents of these observers were each assigned for a second time three months later. We evaluated intra-observer and inter-observer agreement by Kappa test and Kendall tau-b test, respectively. The variability among all observers with different levels of experience was assessed by intraclass correlation coefficients. Results The intra-observer agreement of all compo- nent scores and sum score indicated by Kappa test were 0.889, 0.817, 0.787, and 0.693 （0.897, 0. 834, 0.830, and 0. 708 for the other resident）. The inter-observer agreement of all component scores and sum score indicated by Kendall tau-b test were 0.896, 0.832, 0.847, and 0.832, respec- tively. On the Bland-Airman graph, more than 90% of the sites for each DAP components were loca- ted in the 95% confidence interval within the reference line. The agreement between more clinically experienced surgeons was higher than juniors. Conclusions The diameter-axial-polar system is a reliability and repeatability tool with adequate agreement among different observers and by the same observers.