B. Burnand et al., RELIABILITY OF PANEL-BASED GUIDELINES FOR COLONOSCOPY - AN INTERNATIONAL COMPARISON, Gastrointestinal endoscopy, 47(2), 1998, pp. 162-166
Background: This study examined the reliability of explicit guidelines
developed using the RAND-UCLA appropriateness method. Methods: The ap
propriateness of over 400 indications for colonoscopy was rated by two
multispecialty expert panels (United States and Switzerland). A nine-
point scale was used, which was consolidated into three categories of
appropriateness: appropriate, uncertain, inappropriate. The distributi
on of appropriateness ratings between the two panels and the intrapane
l and interpanel agreement for categories of appropriateness were calc
ulated for all possible indications. Similar statistics were calculate
d for a series of 577 primary care patients referred for colonoscopy i
n Switzerland. Results: Over 80% of all indications (348) could be dir
ectly compared. The proportions of indications classified as appropria
te, uncertain, or inappropriate were 28.4%, 24.7%, 46.6% and 33.0%, 23
.0%, 44.0% for the U.S. and the Swiss panels, respectively. Interpanel
agreement was excellent for all the possible indications (kappa value
: 0.75) and lower for actual cases (kappa value: 0.51) because of lowe
r agreement for the most frequently encountered indications. Conclusio
ns: Good agreement between the two sets of criteria was found, pointin
g to the reliability of the method. Partial disagreement occurred esse
ntially for a few, albeit frequently encountered, indications for use
of colonoscopy in cases of uncomplicated lower abdominal pain or const
ipation.