Inter‐observer variability of two grading systems for equine glandular gastric disease

Tallon, Rose; Hewetson, Michael

doi:10.1111/evj.13334

Cited by 12 publications

(11 citation statements)

References 25 publications

(54 reference statements)

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“…Although recommended by multiple consensus statements (Sykes, Hewetson, et al, 2015;Rendle et al, 2018), these results suggest that the current descriptive grading system is not repeatable between observers. This is further confirmed by Tallon and Hewetson (2020) who demonstrated no agreement when using all four descriptors (severity, shape, appearance and distribution) combined and only weak agreement for each individual descriptor. The limited agreement seen in the present study was unexpected, the four observers in this study work together, are all experienced equine medicine clinicians and perform gastroscopy daily, therefore theoretically should be more likely to agree.…”

Section: Discussionmentioning

confidence: 75%

“…The limited agreement seen in the present study was unexpected, the four observers in this study work together, are all experienced equine medicine clinicians and perform gastroscopy daily, therefore theoretically should be more likely to agree. Tallon and Hewetson (2020) found that agreement did improve with experience; however, agreement was still considered to be poor among the diplomate group. It must be considered that the current system may be obsolete due to the limited repeatability and therefore other methods of grading lesions should be investigated.…”

Section: Discussionmentioning

confidence: 99%

“…The aim of the present study was to document the reliability of EGGD lesion descriptors using the European College of Equine Internal Medicine (ECEIM) consensus guidelines using four blinded observers who work together. Previous work has demonstrated no agreement when using all four descriptors combined and only weak agreement for each individual descriptor (Tallon & Hewetson, 2020). Our hypothesis was that there would be good agreement for all lesions as the four blinded observers all work together daily including sharing clinical cases.…”

Section: Introductionmentioning

confidence: 95%

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Assessment of agreement using the equine glandular gastric disease grading system in 84 cases

Pratt

Bowen

Hallowell

et al. 2022

Veterinary Medicine & Sci

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Introduction Equine glandular gastric disease (EGGD) is a common condition causing signs of gastric pain although lesions are highly variable in their appearance. The only definitive method to diagnose EGGD ante‐mortem is gastroscopy. The current recommended method for describing these lesions is the European College of Equine Internal Medicine (ECEIM) guidelines; however, repeatability between users is variable. This study aimed to validate the reliability of lesion descriptions using ECEIM consensus guidelines, using four blinded equine internal medicine diplomates. Methods Ninety‐two horses with EGGD with pre‐ and post‐treatment gastroscopy images were identified using the electronic record at a UK equine hospital between 2012 and 2019. Eight horses were excluded due to non‐diagnostic images. Four blinded observers used the recommended grading system to describe images and outcomes. Intraclass correlation coefficients and Krippendorff's alpha were used to determine reliability and agreement, respectively. Results Intraclass correlation coefficient for severity was 0.782 (95% confidence interval [CI] 0.722–0.832), for distribution was 0.671 (95% CI 0.540–0.763), for the descriptor raised was 0.635 (95% CI 0.479–0.741), fibrinosuppurative was 0.745 (95% CI 0.651–0.812), haemorrhagic was 0.648 (95% CI 0.513–0.744), hyperaemic was 0.389 (95% CI 0.232–0.522) and for outcome was 0.677 (95% CI 0.559–0.770). Krippendorff's alpha for severity was 0.466 (95% CI 0.466–0.418), for distribution was 0.304 (95% CI 0.234–0.374), for the descriptor raised was 0.268 (95% CI 0.207–0.329), fibrinosuppurative was 0.406 (95% CI 0.347–0.463), haemorrhagic was 0.287 (95% CI 0.229–0.344), hyperaemic was 0.112 (95% CI 0.034–0.188) and for outcome was 0.315 (95% CI 0.218–0.408). There was moderate reliability determined between observers using intra‐class correlation coefficients and unacceptable agreement determined between observers using Krippendorff's alpha. Discussion These results suggest that the current grading system is not comparable between observers, indicating the need to review the grading system or define more robust criteria.

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 95%

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Assessment of agreement using the equine glandular gastric disease grading system in 84 cases

Pratt

Bowen

Hallowell

et al. 2022

Veterinary Medicine & Sci

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“…Inter‐observer and intra‐observer variability have been calculated for other imaging modalities with varying results. Inter‐observer agreement for a glandular gastric ulcer study done by Tallon and Hewetson (2020) using flexible endoscopy resulted in poor inter‐observer agreement. In contrast, Perkins et al (2009) examined resting endoscopic grading of recurrent laryngeal neuropathy, where inter‐observer agreement was substantial and concordance within observers was nearly perfect.…”

Section: Discussionmentioning

confidence: 99%

Blinded comparison of mirror and endoscopic oral examination in the horse: Sensitivity, specificity and observer agreement

Chiero

Reiswig

Griffin

et al. 2022

Equine Veterinary Education

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Summary Background Dental disease is commonly encountered in equine veterinary practice. Due to the horse's deep oral cavity, direct visual examination alone is not adequate for a complete oral evaluation. Typically, a long‐handled dental mirror is used as a visual aid. Oral endoscopy is another option to improve visual examination of the mouth. Although recent literature suggests endoscopy is superior to mirror examination, these modalities have not been compared in a blinded study. Objective The objective of the study was to compare the sensitivity and specificity of identifying dental pathologies between oral mirror and rigid endoscopic examination, as well as evaluating the inter‐ and intra‐observer variability of each modality. Study design Prospective randomised trial. Methods Twenty‐one horses underwent oral examination using a mirror and an endoscope with video recording of both techniques. An additional six horses received both premortem and post‐mortem examinations. Two blinded observers evaluated the video recordings and identified the presence of dental pathology to determine inter‐observer and intraobserver agreement. Live examinations were compared with the six post‐mortem examinations to determine sensitivity and specificity. Results Endoscopy sensitivity was far superior to mirror for all pathologies (83% vs. 39%), while specificity was high for both (71% vs. 87%, respectively) when compared to the gold‐standard post‐mortem examination. Inter‐observer agreement for the presence of pathology using endoscopy was substantial and higher than mirror examination. Intra‐observer agreement was moderate to substantial. Main limitations The study was limited by the small number of horses and post‐mortem examinations, although sample size was increased by assessing the pathology of each tooth. Conclusions Moderate to substantial agreement was found using both endoscopy and mirror examination. Sensitivity was improved with endoscopy. Oral endoscopy may be beneficial for use in monitoring dental disease over time, as many minor pathologies do not require immediate intervention. Endoscopic and mirror videos may also prove valuable in veterinary education.

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“…A reliable grading system is also important for comparison of lesions when assessing response to treatment, particularly if more than one person in the practice is performing the gastroscopy. With these limitations in mind, the interobserver reliability of this descriptive system was recently assessed and was found to be poor (Tallon and Hewetson 2021).…”

Section: Diagnosismentioning

confidence: 99%

Managing glandular gastric disease in horses

Hewetson¹

2021

In Practice

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Background: Equine glandular gastric disease (EGGD) is an erosive disease of the glandular mucosa of the stomach, which is increasingly recognised as a potential cause of poor performance, girthing pain and behavioural changes in sport horses. Unfortunately, the cause of EGGD has not yet been identified, and thus targeted treatment is not possible. Therefore, current recommendations for treatment and prevention are based on acid suppression and management strategies aimed at mitigating known risk factors.Aim of the article: This article summarises what we currently know about EGGD and outlines how we can use this information to manage the disease more effectively.

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Inter‐observer variability of two grading systems for equine glandular gastric disease

Abstract: This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Cited by 12 publications

References 25 publications

Assessment of agreement using the equine glandular gastric disease grading system in 84 cases

Assessment of agreement using the equine glandular gastric disease grading system in 84 cases

Blinded comparison of mirror and endoscopic oral examination in the horse: Sensitivity, specificity and observer agreement

Managing glandular gastric disease in horses

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