RELIABILITY OF PANEL-BASED GUIDELINES FOR COLONOSCOPY - AN INTERNATIONAL COMPARISON

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.