P-026 Effect of Standardized Scoring Conventions on Inter-Rater Reliability in the Endoscopic Evaluation of Crohn's Disease. (March 2016)

• Record Type: Journal Article
• Authors: Dubcenco, Elena; Zou, GuangYong; Stitt, Larry; Baker, Jeffrey; Jeejeebhoy, Khursheed; Kandel, Gabor; Kim, Young-in; Grover, Samir; McDonald, John; Shackelton, Lisa; Khanna, Reena; D'Haens, Geert; Sandborn, William; Vandervoort, Margaret; Feagan, Brian; Levesque, Barrett
• Is Part Of: Inflammatory bowel diseases. Volume 22(2016:Mar.)Supplement 1
• Publication Date: 2016-03
• Subjects: Inflammatory bowel diseases -- Periodicals; Colitis, Ulcerative -- Periodicals; Crohn Disease -- Periodicals; Inflammatory Bowel Diseases -- Periodicals; 616.344
• DOI: 10.1097/01.MIB.0000480117.43672.38
• Languages: English
• ISSNs: 1078-0998

Abstract

Abstract : Background: The Crohn's Disease Endoscopic Index of Severity (CDEIS) 1 and the Simple Endoscopic Score for Crohn's Disease (SES-CD) 2 are commonly used in clinical trials to evaluate endoscopic disease activity. Scoring of these instruments by expert central readers (ECRs) has become standard practice in trials of new therapies in an attempt to increase trial efficiency by reducing bias and measurement variability. 3 Both endoscopic indices (EIs) have demonstrated substantial inter- and intra-rater reliability when scored by ECRs, however some index items have low reliability. Previously identified sources of low reliability include differentiating superficial from deep ulceration, estimation of disease extent, scoring of aphthoid and anastomotic ulcers, defining ulcer location within segments, evaluating anal lesions, scoring ulcers beyond stenotic segments and consistently classifying the location of stenoses. 4 We evaluated the application of scoring conventions to improve the reliability of these items. Methods: Five gastroenterologists at an academic hospital with no prior experience scoring the CDEIS or SES-CD were trained on the use of these indices. Sixty-five video recordings of colonoscopies were scored blindly by each gastroenterologist prior to and after additional training on index scoring conventions. Changes in intra-class correlation coefficients (ICCs) were used to quantify the effect of application of these conventions on the reliability of the CDEIS, SES-CD and a Global Evaluation of Lesion Severity (GELS) score. Results: Following the application of scoring conventions, inter-rater ICCs (95% confidence interval [CI]) for scoring of the total SES-CD score increased from 0.78 (0.71–0.85) to 0.85 (0.79–0.89). Inter-rater ICCs for the total CDEIS and GELS scores were not affected: the corresponding inter-rater ICCs were 0.74 (0.65–0.81) and 0.49, (0.38–0.61) prior to, and 0.73 (0.65–0.81) and 0.53 (0.42–0.64) following application of scoring conventions. Estimation of ulcer depth, surface area, anatomic location and stenosis were again identified as important sources of variability. Conclusions: Use of scoring conventions developed by ECRs enhanced the reliability of the SES-CD but did not similarly affect the CDEIS or GELS. Our data demonstrate that the SES-CD is more reliable than the CDEIS and can be improved with targeted training. It is therefore the preferred instrument for use in clinical trials.