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How "gold" is the standard? Interobservers' variation on venograms
E Kalodiki1, A N Nicolaides, A Al-Kutoubi
1Academic Surgical Unit, Imperial College of Science Technology and School of Medicine at St. Mary' Hospital, London, United Kingdom.
Summary
Radiologist experience impacts deep venous thrombosis diagnosis on venograms. Differences in reporting can influence thromboprophylaxis study outcomes and anticoagulation decisions.
Area of Science:
- Radiology
- Vascular Imaging
- Thrombosis Research
Background:
- Assessing inter-radiologist agreement in venogram interpretation.
- Evaluating the impact of reporting discrepancies on thromboprophylaxis study outcomes.
Purpose of the Study:
- Determine radiologist agreement levels for 151 venograms.
- Assess if disagreement affects thromboprophylaxis study results and anticoagulation decisions.
Main Methods:
- Bilateral venography in 78 total hip replacement patients (postoperative days 8-12).
- Patients received low molecular weight heparin (enoxaparin) +/- TED stockings or placebo.
- Each venogram was reported by four radiologists with varying experience levels.
Main Results:
- Overall deep venous thrombosis incidence was 42%.
- Inter-radiologist agreement (Kappa values) ranged from 0.568 to 0.669.
- Discrepancies in thrombi diagnosis between individual radiologists and a panel reached up to 16%, reduced to 8% for clinically significant proximal thrombi.
Conclusions:
- Radiologist experience and reporting frequency influence venogram interpretation.
- Consider inter-reader variability when designing thromboprophylaxis studies.