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Inter-observer agreement of canine and feline paroxysmal event semiology and classification by veterinary neurology specialists and non-specialists

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Abstract
Background: Advances in mobile technology mean vets are now commonly presented with videos of paroxysmal events by clients, but the consistency of the interpretation of these videos has not been investigated. The objective of this study was to investigate the level of agreement between vets (both neurology specialists and non-specialists) on the description and classification of videos depicting paroxysmal events, without knowing any results of diagnostic workup. An online questionnaire study was conducted, where participants watched 100 videos of dogs and cats exhibiting paroxysmal events and answered questions regarding: epileptic seizure presence (yes/ no), seizure type, consciousness status, and the presence of motor, autonomic and neurobehavioural signs. Agreement statistics (percentage agreement and kappa) calculated for each variable, with prevalence indices calculated to aid their interpretation. Results: Only a fair level of agreement (kappa = 0.40) was found for epileptic seizure presence. Overall agreement of seizure type was moderate (kappa = 0.44), with primary generalised seizures showing the highest level of agreement (kappa = 0.60), and focal the lowest (kappa = 0.31). Fair agreement was found for consciousness status and the presence of autonomic signs (kappa = 0.21-0.40), but poor agreement for neurobehavioral signs (kappa = 0.16). Agreement for motor signs ranged from poor (kappa = <= 0.20) to moderate (kappa = 0.41-0.60). Differences between specialists and non-specialists were identified. Conclusions: The relatively low levels of agreement described here highlight the need for further discussions between neurology experts regarding classifying and describing epileptic seizures, and additional training of non-specialists to facilitate accurate diagnosis. There is a need for diagnostic tools (e.g. electroencephalogram) able to differentiate between epileptic and non-epileptic paroxysms.
Keywords
ILAE, BIAS, DOGS, Seizure, Epilepsy, Canine, Feline, Video, Paroxysmal event, Agreement, Kappa, SEIZURE SEMIOLOGY, ABSENCE SEIZURES, PREVALENCE, KAPPA, EPILEPSY

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MLA
Packer, Rowena MA, Mette Berendt, Sofie Bhatti, et al. “Inter-observer Agreement of Canine and Feline Paroxysmal Event Semiology and Classification by Veterinary Neurology Specialists and Non-specialists.” BMC VETERINARY RESEARCH 11 (2015): n. pag. Print.
APA
Packer, R. M., Berendt, M., Bhatti, S., Charalambous, M., Cizinauskas, S., De Risio, L., Farquhar, R., et al. (2015). Inter-observer agreement of canine and feline paroxysmal event semiology and classification by veterinary neurology specialists and non-specialists. BMC VETERINARY RESEARCH, 11.
Chicago author-date
Packer, Rowena MA, Mette Berendt, Sofie Bhatti, Marios Charalambous, Sigitas Cizinauskas, Luisa De Risio, Robyn Farquhar, et al. 2015. “Inter-observer Agreement of Canine and Feline Paroxysmal Event Semiology and Classification by Veterinary Neurology Specialists and Non-specialists.” Bmc Veterinary Research 11.
Chicago author-date (all authors)
Packer, Rowena MA, Mette Berendt, Sofie Bhatti, Marios Charalambous, Sigitas Cizinauskas, Luisa De Risio, Robyn Farquhar, Rachel Hampel, Myfanwy Hill, Paul JJ Mandigers, Akos Pakozdy, Stephanie M Preston, Clare Rusbridge, Veronika M Stein, Fran Taylor-Brown, Andrea Tipold, and Holger A Volk. 2015. “Inter-observer Agreement of Canine and Feline Paroxysmal Event Semiology and Classification by Veterinary Neurology Specialists and Non-specialists.” Bmc Veterinary Research 11.
Vancouver
1.
Packer RM, Berendt M, Bhatti S, Charalambous M, Cizinauskas S, De Risio L, et al. Inter-observer agreement of canine and feline paroxysmal event semiology and classification by veterinary neurology specialists and non-specialists. BMC VETERINARY RESEARCH. 2015;11.
IEEE
[1]
R. M. Packer et al., “Inter-observer agreement of canine and feline paroxysmal event semiology and classification by veterinary neurology specialists and non-specialists,” BMC VETERINARY RESEARCH, vol. 11, 2015.
@article{7252780,
  abstract     = {Background: Advances in mobile technology mean vets are now commonly presented with videos of paroxysmal events by clients, but the consistency of the interpretation of these videos has not been investigated. The objective of this study was to investigate the level of agreement between vets (both neurology specialists and non-specialists) on the description and classification of videos depicting paroxysmal events, without knowing any results of diagnostic workup. An online questionnaire study was conducted, where participants watched 100 videos of dogs and cats exhibiting paroxysmal events and answered questions regarding: epileptic seizure presence (yes/ no), seizure type, consciousness status, and the presence of motor, autonomic and neurobehavioural signs. Agreement statistics (percentage agreement and kappa) calculated for each variable, with prevalence indices calculated to aid their interpretation. 
Results: Only a fair level of agreement (kappa = 0.40) was found for epileptic seizure presence. Overall agreement of seizure type was moderate (kappa = 0.44), with primary generalised seizures showing the highest level of agreement (kappa = 0.60), and focal the lowest (kappa = 0.31). Fair agreement was found for consciousness status and the presence of autonomic signs (kappa = 0.21-0.40), but poor agreement for neurobehavioral signs (kappa = 0.16). Agreement for motor signs ranged from poor (kappa = <= 0.20) to moderate (kappa = 0.41-0.60). Differences between specialists and non-specialists were identified. 
Conclusions: The relatively low levels of agreement described here highlight the need for further discussions between neurology experts regarding classifying and describing epileptic seizures, and additional training of non-specialists to facilitate accurate diagnosis. There is a need for diagnostic tools (e.g. electroencephalogram) able to differentiate between epileptic and non-epileptic paroxysms.},
  articleno    = {39},
  author       = {Packer, Rowena MA and Berendt, Mette and Bhatti, Sofie and Charalambous, Marios and Cizinauskas, Sigitas and De Risio, Luisa and Farquhar, Robyn and Hampel, Rachel and Hill, Myfanwy and Mandigers, Paul JJ and Pakozdy, Akos and Preston, Stephanie M and Rusbridge, Clare and Stein, Veronika M and Taylor-Brown, Fran and Tipold, Andrea and Volk, Holger A},
  issn         = {1746-6148},
  journal      = {BMC VETERINARY RESEARCH},
  keywords     = {ILAE,BIAS,DOGS,Seizure,Epilepsy,Canine,Feline,Video,Paroxysmal event,Agreement,Kappa,SEIZURE SEMIOLOGY,ABSENCE SEIZURES,PREVALENCE,KAPPA,EPILEPSY},
  language     = {eng},
  pages        = {11},
  title        = {Inter-observer agreement of canine and feline paroxysmal event semiology and classification by veterinary neurology specialists and non-specialists},
  url          = {http://dx.doi.org/10.1186/s12917-015-0356-2},
  volume       = {11},
  year         = {2015},
}

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