Author + information
- Siqin Ye,
- Leroy Rabbani,
- Christopher Kelly,
- Maureen R. Kelly,
- Matthew Lewis,
- Yehuda Paz,
- Clara Peck,
- Shaline Rao,
- Shepard Weiner and
- Andrew Einstein
The 2009 Appropriate Use Criteria (AUC) for Cardiac Radionuclide Imaging is used to identify nuclear stress tests of limited clinical value. However, the AUC's inter-rater reliability has not been well characterized.
We randomly selected 400 nuclear stress tests performed at a single academic medical center. After two standardized training sessions, AUC categories were assigned independently by 6 raters (2 interns, 2 hospitalists, and 2 cardiology fellows). Gold standard classification was the concordant rating of two board-certified/eligible cardiologists. Inter-rater reliability between pairs of raters was determined using Cohen's kappa. Sensitivity and specificity for identification of inappropriate tests was calculated.
Mean age was 61.5 years; 214 (54%) were female. 256 (64%) tests were rated as appropriate by the two cardiologists, 68 (18%) uncertain, 55 (14%) inappropriate, and 21 (5%) unclassifiable. Cohen's kappa between pairs of raters ranged from 0.37 to 0.71. Sensitivity for identifying inappropriate tests ranged from 47% to 82%; specificity ranged from 85% to 97%. Sensitivity for identification of inappropriate tests correlated poorly with training level.
There is moderate inter-rater reliability for the 2009 AUC for nuclear stress tests. However, there is considerable variation in raters’ ability to identify inappropriate tests. Our results suggest need for further research on how to improve application of AUC in clinical settings.
|Panel A||Panel B|
|Sensitivity||Specificity||Attending||Intern 1||Intern 2||Hospitalist 1||Hospitalist 2||Fellow 1||Fellow 2|
|Intern 1||58%||97%||Intern 1||−||0.61||0.58||0.56||0.44||0.42|
|Intern 2||73%||92%||Intern 2||−||0.58||0.57||0.41||0.52|
|Hospitalist 1||82%||91%||Hospitalist 1||−||0.63||0.44||0.46|
|Hospitalist 2||49%||93%||Hospitalist 2||−||0.53||0.48|
|Fellow 1||47%||85%||Fellow 1||−||0.37|
|Fellow 2||73%||85%||Fellow 2||−|
Poster Sessions, Expo North
Sunday, March 10, 2013, 9:45 a.m.-10:30 a.m.
Session Title: SPECT: Appropriate Use Criteria and Role in Specific Populations
Abstract Category: 21. Imaging: Nuclear
Presentation Number: 1229-356
- 2013 American College of Cardiology Foundation