title: Agreement among observers in the assignment of TransAtlantic Inter-Society Consensus classification and runoff score.
abstract: OBJECTIVE
  Productive communication among clinical practitioners is essential if recommendations regarding practice are to exist. The durability of vascular procedures is often influenced by factors such as lesion classification and runoff quality. It is the purpose of this article to determine how reproducible these measures are in the hands of various specialists who deal extensively with peripheral arterial disease.
  
  
  METHODS
  The peripheral arteriograms of 100 patients undergoing percutaneous intervention were distributed to six specialists (three vascular surgeons, two interventional radiologists, and one interventional cardiologist). Each was provided with the reference document describing TASC II classification, Society for Vascular Surgery (SVS) runoff score, and simplified runoff score. With no further instruction, each individual was asked to assign each angiogram a TASC II class, SVS runoff score, and a simplified runoff score. Comparisons between the scores assigned were made using kappa statistic.
  
  
  RESULTS
  When using the simplified runoff score for grading peripheral arterial disease, there was excellent correlation among readers (k = 0.81; P = .001), even across different specialties. When using TASC II class to grade lesions, there was a greater degree of variation when compared with the simplified runoff score (k = 0.44; P < .05). Finally, there was poor correlation between readers when using the SVS runoff score (k = 0.10; P < .05) and the modified SVS runoff score (k = 0.26; P = .001).
  
  
  CONCLUSIONS
  Descriptors of clinical disease severity are not universally reproducible. The simplified runoff score is reproducible when interpreted by multiple readers across different specialties and can be used without further modification. The TASC II classification may need minor alterations in description to obtain good correlation among readers. Before the SVS runoff score can be universally adapted, it will need to be described in much better detail or significantly modified.
authors.affiliation: Department of Surgery, Huntington Hospital, Keck School of Medicine, University of Southern California, Pasadena, Calif.
authors.forename: Tiffany Y
authors.initials: TY
authors.lastname: Wu
authors.forename: Gregory
authors.initials: G
authors.lastname: Giesler
authors.forename: Gabriel
authors.initials: G
authors.lastname: Herscu
authors.forename: Christian
authors.initials: C
authors.lastname: Ochoa
authors.forename: Richard
authors.initials: R
authors.lastname: Reed
authors.forename: Vincent
authors.initials: V
authors.lastname: Rowe
authors.forename: Babak
authors.initials: B
authors.lastname: Yaghmai
authors.forename: Steven G
authors.initials: SG
authors.lastname: Katz
mesh_terms: D017130:Angioplasty / Q000295:instrumentation; D002983:Clinical Competence; D003661:Decision Support Techniques; D006801:Humans; D059032:Learning Curve; D035002:Lower Extremity / Q000098:blood supply*; D015588:Observer Variation; D058729:Peripheral Arterial Disease / Q000145:classification / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000628:therapy; D011237:Predictive Value of Tests; D011859:Radiography; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013043:Specialties, Surgical; D015607:Stents; D009626:Terminology as Topic