Inter-observer agreement for Crohn's disease sub-phenotypes using the Montreal Classification: How good are we? A multi-centre Australasian study

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dc.contributor.authorKrishnaprasad, K.
dc.contributor.authorAndrews, J.
dc.contributor.authorLawrance, I.
dc.contributor.authorFlorin, T.
dc.contributor.authorGearry, R.
dc.contributor.authorLeong, R.
dc.contributor.authorMahy, G.
dc.contributor.authorBampton, P.
dc.contributor.authorProsser, R.
dc.contributor.authorLeach, P.
dc.contributor.authorChitti, L.
dc.contributor.authorCock, C.
dc.contributor.authorGrafton, R.
dc.contributor.authorCroft, A.
dc.contributor.authorCooke, S.
dc.contributor.authorDoecke, J.
dc.contributor.authorRadford-Smith, G.
dc.date.issued2012
dc.description.abstract<h4>Background</h4>Crohn's disease (CD) exhibits significant clinical heterogeneity. Classification systems attempt to describe this; however, their utility and reliability depends on inter-observer agreement (IOA). We therefore sought to evaluate IOA using the Montreal Classification (MC).<h4>Methods</h4>De-identified clinical records of 35 CD patients from 6 Australian IBD centres were presented to 13 expert practitioners from 8 Australia and New Zealand Inflammatory Bowel Disease Consortium (ANZIBDC) centres. Practitioners classified the cases using MC and forwarded data for central blinded analysis. IOA on smoking and medications was also tested. Kappa statistics, with pre-specified outcomes of κ>0.8 excellent; 0.61-0.8 good; 0.41-0.6 moderate and ≤0.4 poor, were used.<h4>Results</h4>97% of study cases had colonoscopy reports, however, only 31% had undergone a complete set of diagnostic investigations (colonoscopy, histology, SB imaging). At diagnosis, IOA was excellent for age, κ=0.84; good for disease location, κ=0.73; only moderate for upper GI disease (κ=0.57) and disease behaviour, κ=0.54; and good for the presence of perianal disease, κ=0.6. At last follow-up, IOA was good for location, κ=0.68; only moderate for upper GI disease (κ=0.43) and disease behaviour, κ=0.46; but excellent for the presence/absence of perianal disease, κ=0.88. IOA for immunosuppressant use ever and presence of stricture were both good (κ=0.79 and 0.64 respectively).<h4>Conclusion</h4>IOA using MC is generally good; however some areas are less consistent than others. Omissions and inaccuracies reduce the value of clinical data when comparing cohorts across different centres, and may impair the ability to translate genetic discoveries into clinical practice.
dc.description.statementofresponsibilityKrupa Krishnaprasad, Jane M. Andrews, Ian C. Lawrance, Timothy Florin, Richard B. Gearry, Rupert W.L. Leong, Gillian Mahy, Peter Bampton, Ruth Prosser, Peta Leach, Laurie Chitti, Charles Cock, Rachel Grafton, Anthony A. Croft, Sharon Cooke, James D. Doecke, Graham L. Radford-Smith
dc.identifier.citationJournal of Crohn's and Colitis, 2012; 6(3):287-293
dc.identifier.doi10.1016/j.crohns.2011.08.016
dc.identifier.issn1873-9946
dc.identifier.issn1876-4479
dc.identifier.orcidAndrews, J. [0000-0001-7960-2650]
dc.identifier.urihttp://hdl.handle.net/2440/72633
dc.language.isoen
dc.publisherElsevier BV
dc.rightsCrown copyright © 2011 Published by Elsevier B.V. All rights reserved.
dc.source.urihttps://doi.org/10.1016/j.crohns.2011.08.016
dc.subjectCrohn's disease
dc.subjectMontreal Classification
dc.subjectInter-observer agreement
dc.subjectKappa statistics
dc.titleInter-observer agreement for Crohn's disease sub-phenotypes using the Montreal Classification: How good are we? A multi-centre Australasian study
dc.typeJournal article
pubs.publication-statusPublished

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