title: Reliability and initial validation of the ulcerative colitis endoscopic index of severity.
abstract: OBJECTIVE
  We studied the reliability of the previously described Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and validated it with an independent cohort of investigators.
  
  
  METHODS
  We created a new library of 57 videos of flexible sigmoidoscopy and stratified them based on disease severity. Twenty-five investigators were each randomly assigned to assess 28 videos (which included 4 duplicates to assess intraobserver reliability). Investigators were blinded to clinical details except for 2 of 4 duplicated videos (to assess the impact of knowledge of symptoms on assessment). Three descriptors ("vascular pattern", "bleeding", and "erosions and ulcers") comprising the UCEIS were scored with a visual analogue scale (VAS) to assess overall severity. Intrainvestigator and interinvestigator agreement was characterized by κ statistical analysis; reliability ratios were used to compare VAS and UCEIS scores.
  
  
  RESULTS
  There was a high level of correlation between UCEIS scores and overall assessment of severity (correlation coefficient, 0.93). Internal consistency (Cronbach α analysis) was 0.86. Intrainvestigator and interinvestigator reliability ratios for UCEIS scores were 0.96 and 0.88, respectively. Intrainvestigator agreement in determination of the UCEIS score was good (κ = 0.72), with individual descriptors ranging from a κ of 0.47 (for bleeding) to 0.87 (for vascular pattern). Interinvestigator agreement in determination of UCEIS scores was moderate (κ = 0.50), with descriptors ranging from a κ of 0.48 (for bleeding) to 0.54 (for vascular pattern). Intrainvestigator variability in determining UCEIS scores did not change appreciably when a video was presented with clinical details.
  
  
  CONCLUSIONS
  The UCEIS and its components show satisfactory intrainvestigator and interinvestigator reliability. Among investigators, the UCEIS accounted for a median of 86% of the variability in evaluation of overall severity on the VAS when assessing the endoscopic severity of UC and was unaffected by knowledge of clinical details.
authors.affiliation: Translational Gastroenterology Unit, John Radcliffe Hospital, Oxford, England. Electronic address: simon.travis@ndm.ox.ac.uk.
authors.forename: Simon P L
authors.initials: SP
authors.lastname: Travis
authors.forename: Dan
authors.initials: D
authors.lastname: Schnell
authors.forename: Piotr
authors.initials: P
authors.lastname: Krzeski
authors.forename: Maria T
authors.initials: MT
authors.lastname: Abreu
authors.forename: Douglas G
authors.initials: DG
authors.lastname: Altman
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Colombel
authors.forename: Brian G
authors.initials: BG
authors.lastname: Feagan
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Hanauer
authors.forename: Gary R
authors.initials: GR
authors.lastname: Lichtenstein
authors.forename: Philippe R
authors.initials: PR
authors.lastname: Marteau
authors.forename: Walter
authors.initials: W
authors.lastname: Reinisch
authors.forename: Bruce E
authors.initials: BE
authors.lastname: Sands
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Yacyshyn
authors.forename: Patrick
authors.initials: P
authors.lastname: Schnell
authors.forename: Christian A
authors.initials: CA
authors.lastname: Bernhardt
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Mary
authors.forename: William J
authors.initials: WJ
authors.lastname: Sandborn
mesh_terms: D015331:Cohort Studies; D003093:Colitis, Ulcerative / Q000175:diagnosis* / Q000473:pathology*; D016099:Endoscopy, Gastrointestinal / Q000379:methods*; D006801:Humans; D015588:Observer Variation; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D012812:Sigmoidoscopy; D014741:Video Recording
keywords: CI; Disease Activity; Endoscopic Score; Endoscopic Severity; Inflammatory Bowel Disease; UC; UCEIS; Ulcerative Colitis Endoscopic Index of Severity; VAS; confidence interval; ulcerative colitis; visual analogue scale