Inter-observer agreement for Crohn's disease sub-phenotypes using the Montreal Classification: how good are we? A multi-centre Australasian study
Krishnaprasad, Krupa, Andrews, Jane M., Lawrance, Ian C,, Florin, Timothy, Gearry, Richard B., Leong, Rupert W.L., Mahy, Gillian, Bampton, Peter, Prosser, Ruth, Leach, Peta, Chitti, Laurie, Cock, Charles, Grafton, Rachel, Croft, Anthony R., Cooke, Sharon, Doecke, James D., and Radford-Smith, Graham L. (2012) Inter-observer agreement for Crohn's disease sub-phenotypes using the Montreal Classification: how good are we? A multi-centre Australasian study. Journal of Crohn's and Colitis, 6 (3). pp. 287-293.
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Crohn's disease (CD) exhibits significant clinical heterogeneity. Classification systems attempt to describe this; however, their utility and reliability depends on inter-observer agreement (IOA). We therefore sought to evaluate IOA using the Montreal Classification (MC). Methods
De-identified clinical records of 35 CD patients from 6 Australian IBD centres were presented to 13 expert practitioners from 8 Australia and New Zealand Inflammatory Bowel Disease Consortium (ANZIBDC) centres. Practitioners classified the cases using MC and forwarded data for central blinded analysis. IOA on smoking and medications was also tested. Kappa statistics, with pre-specified outcomes of κ > 0.8 excellent; 0.61–0.8 good; 0.41–0.6 moderate and ≤ 0.4 poor, were used. Results
97% of study cases had colonoscopy reports, however, only 31% had undergone a complete set of diagnostic investigations (colonoscopy, histology, SB imaging). At diagnosis, IOA was excellent for age, κ = 0.84; good for disease location, κ = 0.73; only moderate for upper GI disease (κ = 0.57) and disease behaviour, κ = 0.54; and good for the presence of perianal disease, κ = 0.6. At last follow-up, IOA was good for location, κ = 0.68; only moderate for upper GI disease (κ = 0.43) and disease behaviour, κ = 0.46; but excellent for the presence/absence of perianal disease, κ = 0.88. IOA for immunosuppressant use ever and presence of stricture were both good (κ = 0.79 and 0.64 respectively). Conclusion
IOA using MC is generally good; however some areas are less consistent than others. Omissions and inaccuracies reduce the value of clinical data when comparing cohorts across different centres, and may impair the ability to translate genetic discoveries into clinical practice.
|Item Type:||Article (Refereed Research - C1)|
|Keywords:||Crohn's disease; inter-observer agreement; Kappa statistics; Montreal Classification|
|FoR Codes:||11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110307 Gastroenterology and Hepatology @ 100%|
|SEO Codes:||92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920105 Digestive System Disorders @ 60%|
92 HEALTH > 9202 Health and Support Services > 920203 Diagnostic Methods @ 40%
|Deposited On:||14 Feb 2012 16:09|
|Last Modified:||17 Jun 2013 01:43|
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