PDF(Pubmed)
Abstract：
BACKGROUND: Due to limited diagnostic capacity and availability of point-of-care tests, diagnosis of Clade I mpox in the geographical regions most affected is usually on clinical grounds. This may be complicated due to the similarity between mpox and varicella (chickenpox) lesions. Visual assessment of lesions is also used for determining clinical progress and to assess patient outcomes in clinical trials. However, there has been no investigation into whether clinicians can (i) identify Clade I mpox compared to other viral lesions (ii) differentiate between Clade I mpox lesion stages.
RESULTS: The objective of this study was to evaluate inter-rater reliability and agreement between clinicians assessing lesions in patients with Clade I mpox. We presented experienced clinicians with 17 images of Clade I mpox or varicella and asked them to independently indicate the most likely diagnosis-mpox or varicella-and to categorise the lesions according to their stage. When selecting the most likely diagnosis, accuracy varied across all images, the inter-rater reliability was poor (κ = 0.223; z = 10.1) and agreement was moderate (Po = 68%). When categorising lesions according to their type, if a single lesion type was present in the image, inter-rater reliability was moderate (κ = 0.671, z = 40.6) and agreement was good (Po = 78%), but when multiple lesion types were shown in an image, both inter-rater reliability (κ = 0.153, z = 10.5) and agreement (Po = 29%) decreased substantially.
CONCLUSIONS: This study demonstrates that there are presently limitations in using visual assessment to diagnose Clade I mpox and evaluate lesion stage and treatment outcomes, which have an impact on clinical practice, public health and clinical trials. More robust indicators and tools are required to inform clinical, public-health, and research priorities, but these must be implementable in countries affected by mpox.
RESULTS: The objective of this study was to evaluate inter-rater reliability and agreement between clinicians assessing lesions in patients with Clade I mpox. We presented experienced clinicians with 17 images of Clade I mpox or varicella and asked them to independently indicate the most likely diagnosis-mpox or varicella-and to categorise the lesions according to their stage. When selecting the most likely diagnosis, accuracy varied across all images, the inter-rater reliability was poor (κ = 0.223; z = 10.1) and agreement was moderate (Po = 68%). When categorising lesions according to their type, if a single lesion type was present in the image, inter-rater reliability was moderate (κ = 0.671, z = 40.6) and agreement was good (Po = 78%), but when multiple lesion types were shown in an image, both inter-rater reliability (κ = 0.153, z = 10.5) and agreement (Po = 29%) decreased substantially.
CONCLUSIONS: This study demonstrates that there are presently limitations in using visual assessment to diagnose Clade I mpox and evaluate lesion stage and treatment outcomes, which have an impact on clinical practice, public health and clinical trials. More robust indicators and tools are required to inform clinical, public-health, and research priorities, but these must be implementable in countries affected by mpox.
摘要：
背景：由于诊断能力有限和即时测试的可用性，在受影响最严重的地理区域，I型分枝痘的诊断通常基于临床。由于水痘和水痘（水痘）病变之间的相似性，这可能很复杂。病变的视觉评估也用于确定临床进展和评估临床试验中的患者结果。然而,目前还没有调查临床医生是否能(i)与其他病毒病变相比,鉴别出分化枝I型痘(ii)区分分化枝I型痘病变的分期.
结果：本研究的目的是评估评估者间的可靠性和临床医生评估I型进化枝痘患者病变的一致性。我们向经验丰富的临床医生提供了17张CladeI型痘或水痘的图像，并要求他们独立指示最可能的诊断-痘或水痘-并根据病变的分期对病变进行分类。选择最有可能的诊断时，所有图像的精度各不相同，评分者间的可靠性较差(κ=0.223；z=10.1)，一致性中等(Po=68%)。当根据病变类型进行分类时，如果图像中存在单个病变类型，评分者间可靠性中等(κ=0.671，z=40.6)，一致性良好(Po=78%)，但是当图像中显示多种病变类型时，评分者间的可靠性(κ=0.153，z=10.5)和一致性(Po=29%)均大幅下降。
结论：本研究表明，目前使用视觉评估来诊断I型进化枝痘，评估病变阶段和治疗结果存在局限性。这对临床实践有影响，公共卫生和临床试验。需要更强大的指标和工具来告知临床，公共卫生,和研究重点，但是这些必须在受天花影响的国家实施。
结果：本研究的目的是评估评估者间的可靠性和临床医生评估I型进化枝痘患者病变的一致性。我们向经验丰富的临床医生提供了17张CladeI型痘或水痘的图像，并要求他们独立指示最可能的诊断-痘或水痘-并根据病变的分期对病变进行分类。选择最有可能的诊断时，所有图像的精度各不相同，评分者间的可靠性较差(κ=0.223；z=10.1)，一致性中等(Po=68%)。当根据病变类型进行分类时，如果图像中存在单个病变类型，评分者间可靠性中等(κ=0.671，z=40.6)，一致性良好(Po=78%)，但是当图像中显示多种病变类型时，评分者间的可靠性(κ=0.153，z=10.5)和一致性(Po=29%)均大幅下降。
结论：本研究表明，目前使用视觉评估来诊断I型进化枝痘，评估病变阶段和治疗结果存在局限性。这对临床实践有影响，公共卫生和临床试验。需要更强大的指标和工具来告知临床，公共卫生,和研究重点，但是这些必须在受天花影响的国家实施。
