title: Interobserver agreement on endoscopic diagnosis of bleeding peptic ulcers.
abstract: BACKGROUND
  The aim of this prospective study was to evaluate the interobserver agreement of stigmata of recent hemorrhage of bleeding peptic ulcers.
  
  
  METHODS
  Sixty-one consecutive adult patients were enrolled in the study and nine (three junior and six senior) endoscopists reviewed standardized video recordings of endoscopic examinations. Interobserver agreement was evaluated using the kappa (kappa) index, intraclass correlation coefficient, and proportion of agreement. Observer bias and poorly trained observers were investigated.
  
  
  RESULTS
  Interobserver agreement was very good for oozing (kappa = 0.68), good for clot (kappa = 0.51), poor for spurting (kappa = 0.29) and visible vessels (kappa = 0.33), and excellent for the absence of stigmata (kappa = 0.82). Observer bias sometimes occurred and the number of poorly trained observers was low. The kappa indexes were significantly better in senior than in junior investigators: 0.48 +/- 0.16 versus 0.37 +/- 0.26, respectively, p < 0.05. The agreement between the in vivo evaluation and video tape recordings (intraobserver agreement) was good (kappa = 0.60 +/- 0.19). There was no training phenomenon between the first and the second half of the patient group.
  
  
  CONCLUSIONS
  The endoscopic classification of bleeding ulcers might be simplified by limiting grading to a few classes. Special attention should be paid to the training of endoscopists.
authors.affiliation: Service d'Hépato-Gastroentérologie, Centre Hospitalier Général, Le Mans, France.
authors.forename: B
authors.initials: B
authors.lastname: Bour
authors.forename: B
authors.initials: B
authors.lastname: Person
authors.forename: P
authors.initials: P
authors.lastname: Calès
authors.forename: A
authors.initials: A
authors.lastname: Blanchi
authors.forename: P
authors.initials: P
authors.lastname: Burtin
authors.forename: F
authors.initials: F
authors.lastname: Oberti
authors.forename: J
authors.initials: J
authors.lastname: Boyer
authors.forename: M
authors.initials: M
authors.lastname: Kaassis
authors.forename: N
authors.initials: N
authors.lastname: Joundy
authors.forename: J
authors.initials: J
authors.lastname: Fort
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D016145:Endoscopy, Digestive System / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D015588:Observer Variation; D010437:Peptic Ulcer / Q000150:complications* / Q000175:diagnosis; D010438:Peptic Ulcer Hemorrhage / Q000145:classification / Q000175:diagnosis* / Q000209:etiology; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D014741:Video Recording