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Reliability of panel-based guidelines for colonoscopy: an international comparison
B Burnand1, J P Vader, F Froehlich
1Institute of Social and Preventive Medicine and Division of Gastroenterology, Medical Outpatient Clinic, University of Lausanne, Switzerland.
Gastrointestinal Endoscopy
|March 25, 1998
Summary
The RAND-UCLA appropriateness method for colonoscopy guidelines shows strong reliability between expert panels. Minor disagreements were noted for common indications like abdominal pain or constipation.
Area of Science:
- Gastroenterology
- Health Services Research
- Medical Guidelines
Background:
- Assessed the reliability of explicit guidelines developed via the RAND-UCLA appropriateness method.
- Investigated the consistency of expert panel recommendations for colonoscopy indications.
Purpose of the Study:
- To evaluate the reliability and inter-panel agreement of colonoscopy guidelines.
- To determine the appropriateness of over 400 indications for colonoscopy.
Main Methods:
- Two multispecialty expert panels (US and Switzerland) rated over 400 colonoscopy indications using a nine-point appropriateness scale.
- Calculated interpanel agreement using kappa statistics for all indications and a subset of primary care patient cases.
- Classified ratings into appropriate, uncertain, and inappropriate categories.
Main Results:
- Excellent interpanel agreement (kappa=0.75) was observed for all indications.
- Agreement was lower (kappa=0.51) for actual patient cases, particularly for frequently encountered indications.
- Proportions of appropriate, uncertain, and inappropriate indications varied slightly between US and Swiss panels.
Conclusions:
- The RAND-UCLA appropriateness method demonstrates reliability for developing colonoscopy guidelines.
- Partial disagreements were identified for common indications, such as uncomplicated lower abdominal pain or constipation.
- The findings support the validity of the established guidelines for colonoscopy use.