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A Journal on Angiology

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 1998 June;17(2):83-8


language: English

How “gold” is the standard? Interobservers’ variation on venograms

Kalodiki E. 1, Nicolaides A. N. 1, Al-Kutoubi A. 2, Cunningham D. A. 2, Mandalia S. 3

From the Irvine Laboratory for Cardiovascular Investigation and Research 1 Academic Surgical Unit and 2 Departments of Radiology and 3 Academic Department of Public Health Imperial College of Science Technology and School of Medicine at St. Mary’ Hospital, London W2, United Kingdom


Background. The aim of this study was to deter­mine the ­degree of agree­ment ­between radiol­o­gists hav­ing dif­fer­ent lev­els of expe­ri­ence, in report­ing 151 veno­grams inde­pen­dent­ly. It was also aimed to ­assess wheth­er the ­degree of dis­agree­ment would have influ­enced the final out­come of a throm­bo­proph­y­lac­tic study and the deci­sion to anti­co­ag­u­late the ­patients.
Methods. Seventy-eight ­patients under­go­ing total hip replace­ment had bilat­er­al venog­ra­phy on post­op­er­a­tive days 8-12. Patients were allo­cat­ed to ­receive ­either a low molec­u­lar ­weight hep­ar­in (enox­ap­ar­in) with or with­out TED® stock­ings or a pla­ce­bo Each of the 151 veno­grams ­obtained has been report­ed on four times.
Results. The over­all inci­dence of deep ­venous throm­bo­sis was 42% (33 of 78 ­patients). The range of the Kappa value of each radiol­o­gist ver­sus the oth­ers was 0.568 to 0.669. There was a sig­nif­i­cant ­decrease in the inci­dence of deep ­venous throm­bo­sis in the treat­ment ver­sus the pla­ce­bo ­groups. On an inten­tion to treat all diag­nosed throm­bi, a dif­fer­ence of up to 16% was dem­on­strat­ed ­between the ­report of indi­vid­u­al radiol­o­gists and the panel. This dif­fer­ence was ­reduced to 8% when only throm­bi prox­i­mal to the calf were con­sid­ered clin­i­cal­ly sig­nif­i­cant.
Conclusions. These dif­fer­enc­es ­reflect the ­radiologist’s expe­ri­ence and fre­quen­cy of report­ing on veno­grams and ­should be taken into ­account when stud­ies for throm­bo­proph­y­lax­is are ­planned.

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