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Phlebography as the gold standard in thromboprophylactic studies? A multicenter interobserver variation study
P Wille-Jørgensen1, L Borris, L N Jørgensen
1Department of Orthopedics, Aalborg Hospital South, Denmark.
Acta Radiologica (Stockholm, Sweden : 1987)
|January 1, 1992
Summary
Phlebography for deep vein thrombosis diagnosis after hip surgery shows moderate agreement for positive cases (mean 70-80%) but high agreement for negative cases (mean 98%). This uncertainty impacts planning for thrombosis prophylaxis studies.
Area of Science:
- Medical Imaging
- Vascular Surgery
- Thrombosis Research
Background:
- Deep vein thrombosis (DVT) is a significant risk following total hip arthroplasty.
- Accurate diagnosis of DVT is crucial for effective thrombosis prophylaxis.
- Phlebography is a standard diagnostic tool, but its inter-observer reliability requires assessment.
Purpose of the Study:
- To evaluate the inter-observer agreement in diagnosing deep vein thrombosis using phlebography after total hip arthroplasty.
- To quantify the reliability of phlebographic interpretation in the context of postsurgical thromboprophylaxis studies.
Main Methods:
- Phlebography was performed on 451 legs of 241 patients 7-11 days after total hip arthroplasty.
- Four independent observers initially evaluated the phlebograms.
- A consensus reading was established for images with initial disagreements.
Main Results:
- Agreement on positive thrombosis diagnosis among primary observers ranged from 65% to 83% (mean 70%).
- Agreement on negative thrombosis diagnosis was high, ranging from 97% to 99% (mean 98%).
- Kappa values indicated moderate to substantial agreement (0.60-0.83) between observers, improving after consensus (0.68-0.90).
Conclusions:
- Phlebography exhibits considerable variability in diagnosing thrombosis post-hip arthroplasty.
- High agreement for negative findings suggests phlebography is reliable in ruling out DVT.
- The inherent uncertainty in positive phlebographic diagnoses necessitates careful consideration in designing thromboprophylaxis trials.