Appropriateness of surgery for sciatica: reliability of guidelines from expert panels.
METHODS
Reliability study of guidelines development.


OBJECTIVE
To compare criteria for low back surgery between two expert panels.


BACKGROUND
Reliability of expert panels for determining appropriateness of indications for surgical procedures has heretofore received little attention.


METHODS
Two multidisciplinary expert panels of similar composition were convened, in the United States and in Switzerland, to evaluate the appropriateness of 720 distinct clinical scenarios involving sciatica. Each indication was assigned to a category of appropriate, uncertain, and inappropriate. The appropriateness of the 720 theoretical scenarios were compared between the two panels, and both sets of criteria were applied to two series of actual cases.


RESULTS
Seventy-nine percent (n = 566) of the 720 theoretical indications were assigned to identical categories of appropriateness by both panels (kappa = 0.63; P < 0.001). Only 2 of the 720 scenarios elicited frank disagreement. The percentage of the 720 indications that were considered appropriate differed between the two panels (U.S.: 3%; Swiss: 11%, P < 0.001), as did the percentage of intrapanel agreement for indications (U.S.: 51%, Swiss: 64%, P < 0.001). When the same theoretical scenarios were matched with two series of actual cases (n = 181 and 149) agreement was moderate (kappa = 0.46) to fair (kappa = 0.30).


CONCLUSIONS
There was substantial agreement on the appropriateness of surgery for theoretical cases of sciatica between independent expert panels from two countries. A better understanding of discordant ratings, especially for actual cases, should precede attempts at transposing recommendations emanating from a panel in one country to another.
Vader
J P
JP
Institute of Social and Preventive Medicine, University of Lausanne, Lausanne, Switzerland. John-Paul.Vader@inst.hospvd.ch
Porchet
F
F
Larequi-Lauber
T
T
Dubois
R W
RW
Burnand
B
B
D005104:Expert Testimony; D017408:Guidelines as Topic; D006300:Health Services Misuse; D006801:Humans; D007796:Laminectomy / Q000592:standards* / Q000706:statistics & numerical data; D008159:Lumbar Vertebrae / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic / Q000592:standards*; D015203:Reproducibility of Results; D012585:Sciatica / Q000601:surgery*; D013557:Switzerland; D014481:United States