title: Interobserver variability in the assessment of the clinical severity of superficial venous insufficiency.
abstract: BACKGROUND
  The clinical class C, of the CEAP classification (Clinical-Etiology-Anatomy-Pathophysiology), is often used when selecting patients for treatment within the national healthcare system. The aim of this study was to test the interobserver reproducibility of C when used in a clinical situation where the decision for reimbursement was made.
  
  
  METHODS
  An unselected series of 78 patients (106 limbs) with varicose veins were examined by three independent surgeons with regard to C of CEAP and whether there was a medical indication for treatment. Interobserver reproducibility was calculated with kappa statistic.
  
  
  RESULTS
  Total agreement between the three observers for clinical class was obtained in 61% of all cases (κ .55-.68 (95% CI)) and for medical indication in 60% of all cases (κ.35-.57 (95% CI)).
  
  
  CONCLUSIONS
  The reproducibility of C when deciding medical indication for treatment is moderate. This may be due to inherent difficulties in the CEAP, lack of specific training, or the simultaneous assessment of reimbursement that may influence the clinical classification.
authors: Department of Surgery, Capio S:t Gorans Hospital, Stockholm, Sweden helen.sinabulya@capiostgoran.se.
authors: Helen
authors: H
authors: Sinabulya
authors: Venous Centre, Stockholm, Sweden.
authors: A
authors: A
authors: Holmberg
authors: Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
authors: L
authors: L
authors: Blomgren
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D014648:Varicose Veins / Q000473:pathology*; D014680:Veins / Q000473:pathology; D014689:Venous Insufficiency / Q000175:diagnosis* / Q000503:physiopathology; D055815:Young Adult
keywords: CEAP clinical class; chronic venous disease; chronic venous insufficiency; classification of venous disease; varicose veins