title: Interobserver agreement in defecography--an international study.
abstract: BACKGROUND
  Defecography is considered to be an essential investigation in the evaluation of functional anorectal disorders, but the agreement between observers from different clinical centers has never been evaluated.
  
  
  METHODS
  14 defecographic studies were selected aimed to cover the most relevant defecographic findings responsible for disordered defecation. Eight studies were considered unequivocal, but six were thought to be controversial. All were sent to the ten participants in Europe and the US (five proctosurgeons, three radiologists, two gastroenterologists). They evaluated the studies using a previously agreed upon questionnaire. Interobserver agreement was quantified by kappa statistics and by the proportions of positive and negative agreement as compared to chance agreement, respectively.
  
  
  RESULTS
  Overall, only the completeness of rectal emptying and the presence of a rectocele achieved acceptable kappa values above 0.4. When restricting the evaluation to the studies considered to be unequivocal, agreement improved considerably and was moderate to good for all items describing the images (kappa 0.43-0.63). However, whether proctosurgery should be performed and whether defecography contributed to the management of the particular patient remained controversial with very low kappa.
  
  
  CONCLUSIONS
  It is doubtful whether defecography contributes substantially to the management of patients with disordered defecation.
authors.affiliation: Department of Internal Medicine, Park-Klinik Weissensee, Berlin, Germany.
authors.forename: S A
authors.initials: SA
authors.lastname: Müller-Lissner
authors.forename: D C
authors.initials: DC
authors.lastname: Bartolo
authors.forename: J
authors.initials: J
authors.lastname: Christiansen
authors.forename: O
authors.initials: O
authors.lastname: Ekberg
authors.forename: R
authors.initials: R
authors.lastname: Goei
authors.forename: W
authors.initials: W
authors.lastname: Höpfner
authors.forename: A
authors.initials: A
authors.lastname: Infantino
authors.forename: H C
authors.initials: HC
authors.lastname: Kuijpers
authors.forename: F
authors.initials: F
authors.lastname: Selvaggi
authors.forename: A
authors.initials: A
authors.lastname: Wald
mesh_terms: D001004:Anus Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D003431:Cross-Cultural Comparison; D019841:Defecography / Q000706:statistics & numerical data*; D005060:Europe; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D012002:Rectal Diseases / Q000000981:diagnostic imaging / Q000209:etiology; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014481:United States