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The agreement of the endoscopic Modified Lund-Kennedy scoring in a clinical research group: An observational study - 13/10/21

Doi : 10.1016/j.anorl.2021.08.014 
I. Tepeš a, T. Košak Soklič a, b, J. Urbančič a, b,
a Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloska 2, SI-1000 Ljubljana, Slovenia 
b Faculty of Medicine, University of Ljubljana, Vrazov trg 2, SI-1000 Ljubljana, Slovenia 

Corresponding author. Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre Ljubljana, Zaloska 2, SI-1000 Ljubljana, Slovenia.Department of Otorhinolaryngology and Cervicofacial Surgery, University Medical Centre LjubljanaZaloska 2LjubljanaSI-1000Slovenia
Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Wednesday 13 October 2021

Abstract

Objectives

The main objective was to prove the robustness of the modified Lund-Kennedy staging system and its use in the clinical research group. Secondary objectives were to evaluate the physicians’ homogeneity, identify outliers with an unacceptable agreement and define factors for questionable agreement within the group of raters.

Material and methods

Anonymized endoscopic photos of patients with chronic rhinosinusitis were assessed by independent raters from a clinical research group. The level of agreement between raters was calculated using intra-class correlation and weighted kappa coefficient. Clusters of similarity were identified using Inter-Item Correlation Matrix. The weighted kappa coefficient was calculated for the most homogeneous group and outliers. Age, sex, consultancy years, combined clinical and research work assessed by 5 senior peers were also statistically compared between raters.

Results

Intraclass-correlation coefficients were 0.75 and 0.95 for respectively single and average measures. Single measures value for most homogenous raters was 0.97 (weighted kappa 0.88, (P<0.001). One outlier with less research work score had an unacceptable agreement for single measures coefficient values with the 2 most homogenous raters (respectively 0.59, weighted kappa 0.15, P=0.32 and 0.57, weighted kappa 0.197, P=0.32). Pooled groups were similar in age (P=0.3), sex (P=0.1) and consultancy years (P=0.2) but significantly differentiated in peer-assessed clinical and research work score (P<0.001).

Conclusion

Even with a perfect overall agreement, careful examination of correlation matrix revealed an obvious outlier with less than ideal performance. The method may be helpful when studies using endoscopic staging system are designed to involve researchers from different backgrounds. When exploring the most common factors, education and clinical experience play a paramount role.

Le texte complet de cet article est disponible en PDF.

Keywords : Chronic rhinosinusitis, Modified Lund-Kennedy scoring, Inter-rater reliability and variability, Nasal polyps


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