PMID- 21813014
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20111110
LR  - 20211020
IS  - 1756-0500 (Electronic)
IS  - 1756-0500 (Linking)
VI  - 4
DP  - 2011 Aug 3
TI  - Indirect calibration between clinical observers - application to the New York 
      Heart Association functional classification system.
PG  - 276
LID - 10.1186/1756-0500-4-276 [doi]
AB  - BACKGROUND: Previous studies showed an inter-observer agreement for the NYHA 
      classification of approximately 55%. The aim of this study was to calibrate the 
      New York Heart Association (NYHA) classification system between observers, 
      increasing its reliability. RESULTS: Among 1136 community-dwellers in Porto, 
      Portugal, aged >/= 45 years, 265 reporting breathlessness answered a 4-item 
      questionnaire to characterize symptom severity. The questionnaire was 
      administered by 7 physicians who also classified the subject's functional 
      capacity according to NYHA. Each subject was assessed by one physician. We 
      calibrated NYHA classifications by the concurrent method, using 1-parameter 
      logistic graded response model. Discrepancies between observers were assessed by 
      differences in ability thresholds between NYHA classes I-II and II-III. The 
      ability estimated by the model was used to predict the NYHA classification for 
      each observer.Estimates of the first and second thresholds for each observer 
      ranged from -1.92 to 0.46 and from 1.42 to 2.30, respectively. The agreement 
      between estimated ability and the observers' NYHA classification was 88% (kappa = 
      0.61). CONCLUSIONS: The study objectively indicates the main reason why several 
      studies have reported low inter-observer is the existence of discrepant 
      thresholds between observers in the definition of NYHA classes. The concurrent 
      method can be used to minimize the reliability problem of NYHA classification.
FAU - Severo, Milton
AU  - Severo M
AD  - Department of Clinical Epidemiology, Predictive Medicine and Public Health, 
      University of Porto Medical School, Porto, Portugal. milton@med.up.pt.
FAU - Gaio, Rita
AU  - Gaio R
FAU - Lourenco, Patricia
AU  - Lourenco P
FAU - Alvelos, Margarida
AU  - Alvelos M
FAU - Bettencourt, Paulo
AU  - Bettencourt P
FAU - Azevedo, Ana
AU  - Azevedo A
LA  - eng
PT  - Journal Article
DEP - 20110803
PL  - England
TA  - BMC Res Notes
JT  - BMC research notes
JID - 101462768
PMC - PMC3160980
EDAT- 2011/08/05 06:00
MHDA- 2011/08/05 06:01
PMCR- 2011/08/03
CRDT- 2011/08/05 06:00
PHST- 2011/06/14 00:00 [received]
PHST- 2011/08/03 00:00 [accepted]
PHST- 2011/08/05 06:00 [entrez]
PHST- 2011/08/05 06:00 [pubmed]
PHST- 2011/08/05 06:01 [medline]
PHST- 2011/08/03 00:00 [pmc-release]
AID - 1756-0500-4-276 [pii]
AID - 10.1186/1756-0500-4-276 [doi]
PST - epublish
SO  - BMC Res Notes. 2011 Aug 3;4:276. doi: 10.1186/1756-0500-4-276.