Abstract：
Thyroid eye disease (TED) can be difficult to manage. The range of available treatments is expanding rapidly; however, cost is a concern and some patients do not respond. The Clinical Activity Score (CAS) was devised as a measure of disease activity and a potential predictor of response to anti-inflammatory treatment. Despite the widespread use of the CAS, inter-observer variability has not been investigated. The aim of the study was to determine the inter-observer variability of the CAS in patients with TED.
Prospective reliability analysis.
Nine patients with a spectrum of clinical features of TED were assessed by 6 experienced observers on the same day. Agreement among the observers was analyzed using the Krippendorff alpha.
The Krippendorff alpha for the total CAS was 0.532 (95% CI = 0.199-0.665), whereas alpha values for the individual components of the CAS varied between 0.171 (CI = 0.000-0.334) for lid redness and 0.671 (CI = 0.294-1.000) for spontaneous pain. Assuming that a CAS value ≥3 implies suitability of the patient for anti-inflammatory treatment, the calculated Krippendorff alpha for agreement among assessors on whether treatment should be given or not given was 0.332 (95% CI = 0.0011-0.5862).
This study has shown unreliable inter-observer variability in total CAS and most individual CAS components, thus highlighting the need for improving the performance of the CAS or seeking other methods to assess activity.
Prospective reliability analysis.
Nine patients with a spectrum of clinical features of TED were assessed by 6 experienced observers on the same day. Agreement among the observers was analyzed using the Krippendorff alpha.
The Krippendorff alpha for the total CAS was 0.532 (95% CI = 0.199-0.665), whereas alpha values for the individual components of the CAS varied between 0.171 (CI = 0.000-0.334) for lid redness and 0.671 (CI = 0.294-1.000) for spontaneous pain. Assuming that a CAS value ≥3 implies suitability of the patient for anti-inflammatory treatment, the calculated Krippendorff alpha for agreement among assessors on whether treatment should be given or not given was 0.332 (95% CI = 0.0011-0.5862).
This study has shown unreliable inter-observer variability in total CAS and most individual CAS components, thus highlighting the need for improving the performance of the CAS or seeking other methods to assess activity.
摘要：
目的：甲状腺眼病（TED）可能难以治疗。可用的治疗范围正在迅速扩大;然而，费用是一个问题，一些患者没有反应。临床活动评分（CAS）被设计为疾病活动的量度和对抗炎治疗反应的潜在预测指标。尽管CAS被广泛使用,观察者间的变异性尚未得到研究。该研究的目的是确定TED患者CAS的观察者间变异性。
方法：前瞻性信度分析。
方法：在同一天由6名经验丰富的观察者评估了9名具有一系列TED临床特征的患者。使用Krippendorffalpha分析了观察者之间的协议。
结果：总CAS的Krippendorffα为0.532（95％CI=0.199-0.665），而CAS各组分的α值在眼睑发红的0.171(CI=0.000-0.334)和自发性疼痛的0.671(CI=0.294-1.000)之间变化。假设CAS值≥3意味着患者适合抗炎治疗，评估人员对是否应给予治疗的一致性计算的Krippendorffα为0.332(95%CI=0.0011~0.5862).
结论：这项研究表明，在总CAS和大多数单独CAS成分中，观察者之间的差异不可靠，因此强调需要提高CAS的绩效或寻求其他方法来评估活动。
方法：前瞻性信度分析。
方法：在同一天由6名经验丰富的观察者评估了9名具有一系列TED临床特征的患者。使用Krippendorffalpha分析了观察者之间的协议。
结果：总CAS的Krippendorffα为0.532（95％CI=0.199-0.665），而CAS各组分的α值在眼睑发红的0.171(CI=0.000-0.334)和自发性疼痛的0.671(CI=0.294-1.000)之间变化。假设CAS值≥3意味着患者适合抗炎治疗，评估人员对是否应给予治疗的一致性计算的Krippendorffα为0.332(95%CI=0.0011~0.5862).
结论：这项研究表明，在总CAS和大多数单独CAS成分中，观察者之间的差异不可靠，因此强调需要提高CAS的绩效或寻求其他方法来评估活动。
