AN ASSESSMENT OF INTER-RATER RELIABILITY IN THE TREATMENT OF CAROTID ARTERY STENOSIS

Abstract

Objective: To determine, through a retrospective case review, if differentsubspecialty physicians will make consistent therapeutic recommendationsfor Carotid artery stenosis.

Methodology: This retrospective cross sectional study included casereview of patients with carotid stenosis presented tofrom July 2004 to March 2005 . Case reviews ofpatients were presented to seven physician-raters specializingrespectively in: Interventional cardiology (2), Vascular surgery (2),Neurology (2), or Interventional Radiology (1). Each physician reviewedcases independently and recommended a therapeutic option. Thephysicians were blinded to previous care provided. To test intra-raterreliability, two case-reviews were repeated.

Result: A total of 22 cases were reviewed . About 154 responses wereobtained. Physician-raters recommended medical management 36% ofthe time, carotid artery stenting 32% of the times and carotidendarterectomy for 24% of the patients. Eight percent (8%) of the time,physicians made other recommendations, such as further diagnosticevaluation. Inter-rater agreement was 77% ( = 0.77). Intra-raterreliability was 93%( =0.93).

Conclusion: A multi-specialty team providing care for carotid arterystenosis patients can reduce “turf battles” among various specialties,resulting in better care for the patients. High Intra-rater reliability of 93%points towards a scientific evidence based approach adopted acrossvarious specialties.