title: Prospective assessment of interobserver agreement for defecography in fecal incontinence.
abstract: OBJECTIVE
  The primary aim of our study was to determine the interobserver agreement of defecography in diagnosing enterocele, anterior rectocele, intussusception, and anismus in fecal-incontinent patients. The subsidiary aim was to evaluate the influence of level of experience on interpreting defecography.
  
  
  METHODS
  Defecography was performed in 105 consecutive fecal-incontinent patients. Observers were classified by level of experience and their findings were compared with the findings of an expert radiologist. The quality of the expert radiologist's findings was evaluated by an intraobserver agreement procedure.
  
  
  RESULTS
  Intraobserver agreement was good to very good except for anismus: incomplete evacuation after 30 sec (kappa, 0.55) and puborectalis impression (kappa, 0.54). Interobserver agreement for enterocele and rectocele was good (kappa, 0.66 for both) and for intussusception, fair (kappa, 0.29). Interobserver agreement for anismus: incomplete evacuation after 30 sec was moderate (kappa, 0.47), and for anismus: puborectalis impression was fair (kappa, 0.24). Agreement in grading of enterocele and rectocele was good (kappa, 0.64 and 0.72, respectively) and for intussusception, fair (kappa, 0.39). Agreement separated by experience level was very good for rectocele (kappa, 0.83) and grading of rectoceles (kappa, 0.83) and moderate for intussusception (kappa, 0.44) at the most experienced level. For enterocele and grading, experience level did not influence the reproducibility.
  
  
  CONCLUSIONS
  Reproducibility for enterocele, anterior rectocele, and severity grading is good, but for intussusception is fair to moderate. For anismus, the diagnosis of incomplete evacuation after 30 sec is more reproducible than puborectalis impression. The level of experience seems to play a role in diagnosing anterior rectocele and its grading and in diagnosing intussusception.
authors.affiliation: Department of Radiology, G1-228, Academic Medical Center, Meibergdreef 9, Amsterdam 1105 AZ, The Netherlands.
authors.forename: Annette C
authors.initials: AC
authors.lastname: Dobben
authors.forename: Tjeerd G
authors.initials: TG
authors.lastname: Wiersma
authors.forename: Lucas W M
authors.initials: LW
authors.lastname: Janssen
authors.forename: Rien
authors.initials: R
authors.lastname: de Vos
authors.forename: Maaike P
authors.initials: MP
authors.lastname: Terra
authors.forename: Cor G
authors.initials: CG
authors.lastname: Baeten
authors.forename: Jaap
authors.initials: J
authors.lastname: Stoker
mesh_terms: D000328:Adult; D000368:Aged; D019841:Defecography; D005242:Fecal Incontinence / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011446:Prospective Studies; D014743:Videotape Recording