INTEROBSERVER AGREEMENT IN DEFECOGRAPHY

PURPOSE: This study was designed to test the reproducibility of the di agnostic assessment of defecographies in patients with a suspected dis order of defecation. METHODS: To evaluate interobserver agreement, 100 defecographic series of patients with complaints suggesting a disorde red defecation were evaluated independently by three observers with a standardized questionnaire. After six weeks, a random sample of 35 of 100 defecographies was evaluated a second time with clinical data prov ided (history, proctologic examination). To evaluate whether the posit ion of residual volume in the rectum would affect agreement, patients with substantial retention either in the upper or lower rectum were al so evaluated separately. RESULTS: Total agreement regarding rectocele and internal prolapse was 0.81 and 0.75, respectively (1.0 = complete agreement), and was significantly higher than chance agreement. Total agreement regarding residual volume in the rectum at the end of defeco graphy and clinical relevance of findings was not different from chanc e agreement, providing clinical data did not significantly improve agr eement. When residual volume was situated in the lower rectum, agreeme nt regarding incompleteness of emptying and its clinical relevance was much better (0.93). CONCLUSIONS: Interobserver agreement is good rega rding the deformation of the rectum during defecography but not differ ent from chance agreement regarding the completeness of evacuation.