HOW GOLD IS THE STANDARD - INTEROBSERVERS VARIATION ON VENOGRAMS

Background The aim of this study was to determine the degree of agreem ent between radiologists having different levels of experience, in rep orting 151 venograms independently. It was also aimed to assess whethe r the degree of disagreement would have influenced the final outcome o f a thromboprophylactic study and the decision to anticoagulate the pa tients. Methods. Seventy-eight patients undergoing total hip replaceme nt had bilateral venography on postoperative days 8-12. Patients were allocated to receive either a low molecular weight heparin (enoxaparin ) with or without TED(R) stockings or a placebo Each of the 151 venogr ams obtained has been reported on four times. Results. The overall inc idence of deep venous thrombosis was 42% (33 of 78 patients). The rang e of the Kappa value of each radiologist versus the others was 0.568 t o 0.669. There was a significant decrease in the incidence of deep ven ous thrombosis in the treatment versus the placebo groups. On an inten tion to treat all diagnosed thrombi, a difference of up to 16% was dem onstrated between the report of individual radiologists and the panel. This difference was reduced to 8% when only thrombi proximal to the c alf were considered clinically significant. Conclusions. These differe nces reflect the radiologist's experience and frequency of reporting o n venograms and should be taken into account when studies for thrombop rophylaxis are planned.