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Inter-observer Variability of Clinical Activity Score: Assessments in Patients With Thyroid Eye Disease
Petros Perros1, Miloš Žarković2, Simon H Pearce1
1From the Department of Endocrinology (P.P., S.H.P., S.R.), Royal Victoria Infirmary, Newcastle upon Tyne, UK; Translational and Clinical Research Institute (P.P., S.H.P., SR), Newcastle University, Newcastle upon Tyne, UK.
American Journal of Ophthalmology
|April 7, 2023
Summary
The Clinical Activity Score (CAS) for thyroid eye disease (TED) shows unreliable results between observers, indicating a need for better assessment methods. This impacts treatment decisions for patients with TED.
Area of Science:
- Ophthalmology
- Endocrinology
- Clinical assessment
Background:
- Thyroid eye disease (TED) management is challenging, with expanding treatment options but concerns about cost and patient response.
- The Clinical Activity Score (CAS) is widely used to gauge TED activity and predict response to anti-inflammatory treatments.
- However, the reliability of CAS scores when used by different clinicians has not been previously evaluated.
Purpose of the Study:
- To assess the inter-observer variability of the Clinical Activity Score (CAS) in patients diagnosed with thyroid eye disease (TED).
- To determine the reliability of CAS in predicting suitability for anti-inflammatory treatment in TED patients.
Main Methods:
- A prospective reliability analysis was conducted.
- Six experienced observers assessed nine TED patients on the same day.
- Inter-observer agreement was quantified using Krippendorff's alpha.
Main Results:
- The overall Krippendorff alpha for the total CAS was 0.532, indicating moderate agreement.
- Individual CAS components showed significant variability, with lid redness (alpha=0.171) being particularly unreliable.
- Agreement on treatment decisions (CAS ≥3) yielded a Krippendorff alpha of 0.332, suggesting low reliability.
Conclusions:
- The study demonstrates significant inter-observer variability in the total CAS and most of its components for thyroid eye disease.
- Current performance of the CAS is unreliable for clinical decision-making in TED.
- There is a critical need to refine the CAS or develop alternative methods for accurately assessing disease activity in TED.
