初次培训后ASPECT评分一致性和准确性的研究

摘要

目的 评价初次培训后Alberta卒中项目早期计算机断层扫描(computed tomography,CT)评分(Alberta Stroke Program Early CT Score,ASPECTS)的一致性和准确性,为其临床应用及推广奠定基础.方法 收集30例起病6 h内脑梗死患者CT及简要临床资料.对不同科室28人(其中影像科21人,神经内科7人)、不同资历(工龄≥10年18人、<10年10人)进行初次培训后,对所有患者入院首次非增强CT(noncontrast CT,NCCT)进行ASPECTS.将ASPECTS作为分类变量,采用Fleiss' Kappa值评估ASPECTS系统的一致性,采用正确率评估ASPECTS系统的准确性.结果 整体ASPECTS的Kappa值为0.102,95%可信区间(confidence interval,CI)为(0.094,0.110);影像科、神经内科评分者的Kappa值及95%CI分别为0.116(0.105,0.128)、0.067(0.034,0.099).正确率:28位评分者整体840例次ASPECTS具体分值的正确率为15.595%;二分法(ASPECTS≥6或<6)为73.571%,差异有统计学意义(P<0.05);不同科室的二分法正确率:影像科74.92%,神经内科69.523%,差异无统计学意义.二分法不同资历正确率:工龄≥10年74.814%,工龄<10年61.665%,差异无统计学意义.结论 初次培训后ASPECTS的一致性与准确性均较低,提示多次、严格ASPECTS培训极为必须和重要;二分法(ASPECTS≥6或ASPECTS<6)有较好的临床应用前景.%Objective To evaluate the consistency and accuracy of Alberta Stroke Program Early Computed Tomography Score (ASPECTS) after the initial training, so as to lay a foundation for the clinical applications and propagations. Methods Brief clinical materials of 30 patients with suspected acute ischemic stroke were collected within 6 hours after onset. A total of 28 employees (21 from imaging department and 7 from neurology department) with different professional working-year (18 people with 10 years or more as senior employees, and the other 10 with less than 10 years as junior employees) were selected to make ASPECTS for all the patients' first admission noncontrast CT (NCCT) after their initial training. The ASPECTS was taken as a categorical variable. Its consistency was evaluated by Fleiss Kappa statistics, and its accuracy was assessed by the correct rate. Results The overall ASPECTS Kappa value was 0.102, and 95% confidence interval was (0.094, 0.110); the raters Kappa value and 95% confidence interval from imaging department was 0.116 (0.105, 0.128); the raters Kappa value and 95% confidence interval from neurology department was 0.067 (0.034, 0.099). Accuracy: the correct rate of 28 raters was 15.595% after 840 case-time ASPECTS in overall. With the method of dichotomy (ASPECTS ≥6 and <6) the correct rate was 73.571%. Statistics result of chi-square test for the two methods had significant difference (P<0.05). The dichotomy correct rate of imaging department and neurology department were 74.92% and 69.523% respectively, which had no significant difference. The correct rate of senior employees and junior ones were 74.814% and 61.665% respectively, which had no significant difference. Conclusion The consistency and the accuracy of ASPECTS were relatively low after the initial training, which indicated that more times and strict trainings were very essential and important and Dichotomy (ASPECTS ≥6 or ASPECTS <6) had a relatively good clinical application prospection.