Indirect calibration between clinical observers - Application to the New York Heart Association functional classification system

• Type: Article in International Scientific Journal
• Date: 2011

Authors

Severo M (Author) FMUP; Gaio, R (Author) FCUP; Lourenco, P (Author) Other; Alvelos, M (Author) Other; Bettencourt, P (Author) FMUP; Azevedo, A (Author) Other

Journal

Title: BMC Research Notes

Vol. 4

Final page: 276

ISSN: 1756-0500

Publisher: Springer Nature

Indexing

ISI Web of Knowledge

Scopus - 11 Citations

Other information

Authenticus ID: P-007-ZHA

DOI: 10.1186/1756-0500-4-276

Abstract (EN): Background: Previous studies showed an inter-observer agreement for the NYHA classification of approximately 55%. The aim of this study was to calibrate the New York Heart Association (NYHA) classification system between observers, increasing its reliability. Results: Among 1136 community-dwellers in Porto, Portugal, aged 45 years, 265 reporting breathlessness answered a 4-item questionnaire to characterize symptom severity. The questionnaire was administered by 7 physicians who also classified the subject's functional capacity according to NYHA. Each subject was assessed by one physician. We calibrated NYHA classifications by the concurrent method, using 1-parameter logistic graded response model. Discrepancies between observers were assessed by differences in ability thresholds between NYHA classes I-II and II-III. The ability estimated by the model was used to predict the NYHA classification for each observer. Estimates of the first and second thresholds for each observer ranged from -1.92 to 0.46 and from 1.42 to 2.30, respectively. The agreement between estimated ability and the observers' NYHA classification was 88% (kappa = 0.61). Conclusions: The study objectively indicates the main reason why several studies have reported low inter-observer is the existence of discrepant thresholds between observers in the definition of NYHA classes. The concurrent method can be used to minimize the reliability problem of NYHA classification. © 2010 Severo et al; licensee BioMed Central Ltd.

Language: English

Type (Professor's evaluation): Scientific