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An EULAR study group pilot study on reliability of simple capillaroscopic definitions to describe capillary morphology in rheumatic diseases

(2016) RHEUMATOLOGY. 55(5). p.883-890
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Abstract
Objective. To propose simple capillaroscopic definitions for interpretation of capillaroscopic morphologies and to assess inter-rater reliability. Methods. The simple definitions proposed were: normal-hairpin, tortuous or crossing; abnormal-not hairpin, not tortuous and not crossing; not evaluable-whenever rater undecided between normal and abnormal. Based upon an aimed kappa of 0.80 and default prevalences of normal (0.4), abnormal (0.4) and not evaluable (0.2) capillaries, 90 single capillaries were presented to three groups of raters: experienced independent raters, n = 5; attendees of the sixth EULAR capillaroscopy course, n = 34; novices after a 1-h course, n = 11. Inter-rater agreement was assessed by calculation of proportion of agreement and by kappa coefficients. Results. Mean kappa based on 90 capillaries was 0.47 (95% CI: 0.39, 0.54) for expert raters, 0.40 (95% CI: 0.36, 0.44) for attendees and 0.46 (95% CI: 0.41, 0.52) for novices, with overall agreements of 67% (95% CI: 63, 71), 63% (95% CI: 60, 65) and 67% (95% CI: 63, 70), respectively. Comparing only normal vs the combined groups of abnormal and not evaluable capillaries did increase the kappa: 0.51 (95% CI: 0.37, 0.65), 0.53 (95% CI: 0.49, 0.58) and 0.55 (95% CI: 0.49, 0.62). On the condition that the capillaries were classifiable, the mean kappa was 0.62 (95% CI: 0.50, 0.74) for expert raters (n = 65), 0.76 (95% CI: 0.69, 0.83) for attendees (n = 20) and 0.81 (95% CI: 0.74, 0.89) for novices (n = 44). Conclusion. This multicentre, international study showed moderate reliability of simple capillaroscopic definitions for describing morphology of capillaries by rheumatologists with varying levels of expertise. Novices were capable of distinguishing normal from abnormal capillaries by means of a 1-h training session. In future studies, the class not evaluable may be obsolete.
Keywords
REVISED CRITERIA, CONNECTIVE-TISSUE DISEASE, SCLEROSIS, CLASSIFICATION, DERMOSCOPY, EULAR study group on microcirculation, definitions, NAILFOLD VIDEOCAPILLAROSCOPY ASSESSMENT, SYSTEMIC-LUPUS-ERYTHEMATOSUS, morphology, reliability, novices, trainees, experts, capillaroscopy

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Chicago
Smith, Vanessa, Sam Beeckman, Ariane L Herrick, Saskia Decuman, Ellen Deschepper, Filip De Keyser, Oliver Distler, et al. 2016. “An EULAR Study Group Pilot Study on Reliability of Simple Capillaroscopic Definitions to Describe Capillary Morphology in Rheumatic Diseases.” Rheumatology 55 (5): 883–890.
APA
Smith, V., Beeckman, S., Herrick, A. L., Decuman, S., Deschepper, E., De Keyser, F., Distler, O., et al. (2016). An EULAR study group pilot study on reliability of simple capillaroscopic definitions to describe capillary morphology in rheumatic diseases. RHEUMATOLOGY, 55(5), 883–890.
Vancouver
1.
Smith V, Beeckman S, Herrick AL, Decuman S, Deschepper E, De Keyser F, et al. An EULAR study group pilot study on reliability of simple capillaroscopic definitions to describe capillary morphology in rheumatic diseases. RHEUMATOLOGY. 2016;55(5):883–90.
MLA
Smith, Vanessa, Sam Beeckman, Ariane L Herrick, et al. “An EULAR Study Group Pilot Study on Reliability of Simple Capillaroscopic Definitions to Describe Capillary Morphology in Rheumatic Diseases.” RHEUMATOLOGY 55.5 (2016): 883–890. Print.
@article{8038902,
  abstract     = {Objective. To propose simple capillaroscopic definitions for interpretation of capillaroscopic morphologies and to assess inter-rater reliability. 
Methods. The simple definitions proposed were: normal-hairpin, tortuous or crossing; abnormal-not hairpin, not tortuous and not crossing; not evaluable-whenever rater undecided between normal and abnormal. Based upon an aimed kappa of 0.80 and default prevalences of normal (0.4), abnormal (0.4) and not evaluable (0.2) capillaries, 90 single capillaries were presented to three groups of raters: experienced independent raters, n = 5; attendees of the sixth EULAR capillaroscopy course, n = 34; novices after a 1-h course, n = 11. Inter-rater agreement was assessed by calculation of proportion of agreement and by kappa coefficients. 
Results. Mean kappa based on 90 capillaries was 0.47 (95\% CI: 0.39, 0.54) for expert raters, 0.40 (95\% CI: 0.36, 0.44) for attendees and 0.46 (95\% CI: 0.41, 0.52) for novices, with overall agreements of 67\% (95\% CI: 63, 71), 63\% (95\% CI: 60, 65) and 67\% (95\% CI: 63, 70), respectively. Comparing only normal vs the combined groups of abnormal and not evaluable capillaries did increase the kappa: 0.51 (95\% CI: 0.37, 0.65), 0.53 (95\% CI: 0.49, 0.58) and 0.55 (95\% CI: 0.49, 0.62). On the condition that the capillaries were classifiable, the mean kappa was 0.62 (95\% CI: 0.50, 0.74) for expert raters (n = 65), 0.76 (95\% CI: 0.69, 0.83) for attendees (n = 20) and 0.81 (95\% CI: 0.74, 0.89) for novices (n = 44). 
Conclusion. This multicentre, international study showed moderate reliability of simple capillaroscopic definitions for describing morphology of capillaries by rheumatologists with varying levels of expertise. Novices were capable of distinguishing normal from abnormal capillaries by means of a 1-h training session. In future studies, the class not evaluable may be obsolete.},
  author       = {Smith, Vanessa and Beeckman, Sam and Herrick, Ariane L and Decuman, Saskia and Deschepper, Ellen and De Keyser, Filip and Distler, Oliver and Foeldvari, Ivan and Ingegnoli, Francesca and M{\"u}ller-Ladner, Ulf and Riccieri, Valeria and Riemekasten, Gabriela and Sulli, Alberto and Voskuyl, Alexandre and Cutolo, Maurizio},
  issn         = {1462-0324},
  journal      = {RHEUMATOLOGY},
  language     = {eng},
  number       = {5},
  pages        = {883--890},
  title        = {An EULAR study group pilot study on reliability of simple capillaroscopic definitions to describe capillary morphology in rheumatic diseases},
  url          = {http://dx.doi.org/10.1093/rheumatology/kev441},
  volume       = {55},
  year         = {2016},
}

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