Expert panel assessment of appropriateness of abdominal aortic aneurysm surgery : global judgement versus probability estimation.
To compare an expert panel's global assessment of appropriateness of elective surgery for abdominal aortic aneurysms (AAA) with their assessment of the effect of surgery on the probability of 5-year mortality.
Nine expert panel members rated the appropriateness of 120 scenarios for elective AAA repair on a nine-point scale, and also estimated the 5-year probability of AAA-related death and of non-AAA related death among 30-day survivors of AAA surgery and among patients with unoperated AAA.
These probabilities were used to determine differences in 5-year probablility of mortality of surgery vs. no surgery for each scenario.
Three categories of appropriateness were defined based on these differences : inappropriate (<0%), equivocal (0-5%), and appropriate (>5%). Results : the distribution of scenarios was inappropriate (39%), equivocal (12%), and appropriate (49%) based on probability estimates and inappropriate (43%), equivocal (22%), and appropriate (36%) based on global assessment.
There was poor agreement between the two methods, with a Kappa coefficient=0.28 (95% CI : 0.23 to 0.32).
Although a higher proportion of scenarios were rated as appropriate using probability estimation rather than global judgment, the level of agreement among members of the panel was similar, Kappa coefficient=0.07 (95% CI : 0.07 to 0.72).
Experts disagree about the appropriate indications for elective surgery for AAA. (...)
Mots-clés Pascal : Evaluation, Méthodologie, Maladie, Mortalité, Information, Santé, Expert, Obésité, Trouble nutrition, Stress, Santé mentale, Chirurgie, Spécialité médicale, Appareil circulatoire pathologie, Anévrysme, Indicateur, Mesure, Trouble anxieux, Vaisseau sanguin pathologie
Mots-clés Pascal anglais : Evaluation, Methodology, Disease, Mortality, Information, Health, Expert, Obesity, Nutrition disorder, Stress, Mental health, Surgery, Medical specialty, Cardiovascular disease, Aneurysm, Indicator, Measurement, Anxiety disorder, Vascular disease
Notice produite par :
ORS Auvergne - Observatoire Régional de la Santé d'Auvergne
Code Inist : 002B30A11. Création : 19/02/1999.