Abstract：
OBJECTIVE: Acute appendicitis is a wide spectrum disease, from simple inflammation to evident intestinal perforation. The correct interpretation of the degree of inflammation is crucial to guarantee appropriate treatment and adherence to protocols and guidelines. In order to investigate this concordance, the authors compared the definition of appendicitis and the predicted treatment among all surgeons affiliated to a single Pediatric Surgery School (consisting of 8 different centers).
METHODS: Twenty-two short recordings of intra-operative manipulation of appendices were shown to 56 surgeons, blindly to clinical information. Four items were collected and analyzed: classification of appendicitis, type and length of predicted antibiotic therapy, day of re-alimentation. Data were analyzed to identify the concordance kappa coefficient, stratified according to expertise of the responding surgeon.
RESULTS: The 1232 evaluations obtained in all valued items low overall concordance. Subgroup analysis identified a good agreement between younger surgeons only in the choice of antibiotic (k 0.47). However, if the centers were divided between University and non-University Hospitals, a strong agreement was found in the former both for classification (k 0.45 vs 0.32) and type of antibiotic (k 0.42 vs 0.24).
CONCLUSIONS: The overall concordance between surgeons in different centers in the diagnostic classification and predicted treatment of appendicitis is quite low. University Hospital have a highest concordance in both items at all levels of expertise; it might be postulated that teaching to younger surgeon increase the comparison between experts and finally the concordance and adherence to protocols within the center.
METHODS: Twenty-two short recordings of intra-operative manipulation of appendices were shown to 56 surgeons, blindly to clinical information. Four items were collected and analyzed: classification of appendicitis, type and length of predicted antibiotic therapy, day of re-alimentation. Data were analyzed to identify the concordance kappa coefficient, stratified according to expertise of the responding surgeon.
RESULTS: The 1232 evaluations obtained in all valued items low overall concordance. Subgroup analysis identified a good agreement between younger surgeons only in the choice of antibiotic (k 0.47). However, if the centers were divided between University and non-University Hospitals, a strong agreement was found in the former both for classification (k 0.45 vs 0.32) and type of antibiotic (k 0.42 vs 0.24).
CONCLUSIONS: The overall concordance between surgeons in different centers in the diagnostic classification and predicted treatment of appendicitis is quite low. University Hospital have a highest concordance in both items at all levels of expertise; it might be postulated that teaching to younger surgeon increase the comparison between experts and finally the concordance and adherence to protocols within the center.
摘要：
目的：急性阑尾炎是一种广谱疾病，从单纯的炎症到明显的肠穿孔。对炎症程度的正确解释对于保证适当的治疗和遵守协议和指南至关重要。为了调查这种一致性，作者比较了阑尾炎的定义和附属于一个儿科外科学校(由8个不同的中心组成)的所有外科医生的预测治疗.
方法：向56名外科医生展示了22条术中操作阑尾的简短记录，盲目地接受临床信息。收集并分析了四个项目：阑尾炎的分类，预测抗生素治疗的类型和长度，再营养的日子。对数据进行了分析，以确定一致性kappa系数，根据反应外科医生的专业知识进行分层。
结果：在所有有价值的项目中获得的1232项评价总体一致性较低。亚组分析发现，年轻外科医生仅在抗生素的选择上有良好的一致性(k0.47)。然而,如果将中心分为大学医院和非大学医院，前者在分类（k0.45vs0.32）和抗生素类型（k0.42vs0.24）方面均具有很强的一致性。
结论：不同中心的外科医生在阑尾炎的诊断分类和预测治疗方面的总体一致性相当低。大学医院在所有专业水平上，这两个项目的一致性最高；可以推测，对年轻外科医生的教学增加了专家之间的比较，最终增加了对中心内协议的一致性和依从性。
方法：向56名外科医生展示了22条术中操作阑尾的简短记录，盲目地接受临床信息。收集并分析了四个项目：阑尾炎的分类，预测抗生素治疗的类型和长度，再营养的日子。对数据进行了分析，以确定一致性kappa系数，根据反应外科医生的专业知识进行分层。
结果：在所有有价值的项目中获得的1232项评价总体一致性较低。亚组分析发现，年轻外科医生仅在抗生素的选择上有良好的一致性(k0.47)。然而,如果将中心分为大学医院和非大学医院，前者在分类（k0.45vs0.32）和抗生素类型（k0.42vs0.24）方面均具有很强的一致性。
结论：不同中心的外科医生在阑尾炎的诊断分类和预测治疗方面的总体一致性相当低。大学医院在所有专业水平上，这两个项目的一致性最高；可以推测，对年轻外科医生的教学增加了专家之间的比较，最终增加了对中心内协议的一致性和依从性。
