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Scoring Endoscopy in Pediatric Inflammatory Bowel Disease: A Way to Improve Quality
Lorenzo Norsa1, Alberto Ferrari2, Serena Arrigo3
1Pediatric Gastroenterology Hepatology and Transplantation.
Insights
Pediatric endoscopists show low agreement when scoring inflammatory bowel disease (IBD) endoscopic activity. Categorizing disease severity improved agreement slightly, highlighting the need for standardized training to enhance interobserver agreement (IOA) in pediatric IBD evaluations.
Area of Science:
- Pediatric Gastroenterology
- Endoscopic Imaging
- Inflammatory Bowel Disease Research
Background:
- Interobserver variability in assessing mucosal lesions of inflammatory bowel disease (IBD) is significant, particularly in pediatric cases.
- Standardized endoscopic scoring systems are crucial for consistent IBD management and research.
Purpose of the Study:
- To evaluate interobserver agreement (IOA) among pediatric endoscopists using validated IBD endoscopic scores.
- To assess the reliability of Ulcerative Colitis Endoscopic Index of Severity (UCEIS) and Simple Endoscopic Score for Crohn Disease (SES-CD) in children.
Main Methods:
- A multicenter prospective observational study involving 11 pediatric endoscopists.
- Evaluation of 15 ileocolonoscopy videos from pediatric IBD patients using UCEIS and SES-CD.
- Statistical analysis including intraclass correlation and Fleiss kappa to determine IOA.
Main Results:
- Low interobserver agreement was observed for both UC (Intraclass correlation: 0.298) and CD (Intraclass correlation: 0.266).
- Disease activity categorization (remission, mild, moderate, severe) improved agreement (Fleiss kappa: 0.408 for UC, 0.552 for CD).
- Individual reviewer characteristics did not significantly impact scoring errors.
Conclusions:
- There is a notable lack of agreement among pediatric endoscopists in applying IBD endoscopic scores.
- Disease activity categorization offers a modest improvement in IOA, especially for Crohn disease.
- Targeted training programs are recommended to enhance IOA in pediatric IBD endoscopic assessments.
Objectives And Study:
There is a large interobserver variability in evaluating mucosal lesions of inflammatory bowel disease (IBD), especially in pediatric patients. This multicenter prospective observational study aims to evaluate interobserver agreement (IOA) among pediatric endoscopists in assigning validated IBD endoscopic scores in children.
Methods:
Fifteen videos of follow-up ileocolonoscopies in children with IBD were recorded and selected as cases. Eleven pediatric endoscopists from different centers blindly evaluated all videos and calculated scores: either Ulcerative Colitis Endoscopic Index of Severity (UCEIS) or Simple Endoscopic Score for Crohn Disease (SES-CD). Scores from all reviewers were compared in order to calculate IOA for general videos and specific sections. Scores from an expert adult reader were used to calculate possible reviewer's characteristics affecting scores' reliability.
Results:
Intraclass correlation was 0.298 (95% confidence interval [CI]: 0.13-0.55) for ulcerative colitis (UC) and 0.266 (0.11-0.52) for Crohn disease (CD). When a disease activity categorization was adopted (remission, mild, moderate, severe activity) Fleiss kappa coefficient was 0.408 (0.29-0.53) for UC and 0.552 (0.43-0.73) for CD. When stratified by item, vascular pattern of UC was the most reliable item IC: 0.624 (0.321-0.854). In multivariable analysis, none of the reviewer's characteristics affected the readers' errors.
Conclusions:
This multicenter study shows low agreement among pediatric endoscopists in evaluating endoscopic scores in children with IBD. By using disease activity categorization, agreement slightly increased, mostly for CD. All readers showed a low-grade concordance with the expert adult gastroenterologist's evaluations. Future-specific training programs should be considered to increase IOA in using IBD endoscopic activity scores.
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