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Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS)
BACKGROUND: Variability in endoscopic assessment necessitates rigorous investigation of descriptors for scoring severity of ulcerative colitis (UC). OBJECTIVE: To evaluate variation in the overall endoscopic assessment of severity, the intra- and interindividual variation of descriptive terms and to...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Group
2011
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3292713/ https://www.ncbi.nlm.nih.gov/pubmed/21997563 http://dx.doi.org/10.1136/gutjnl-2011-300486 |
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author | Travis, Simon P L Schnell, Dan Krzeski, Piotr Abreu, Maria T Altman, Douglas G Colombel, Jean-Frédéric Feagan, Brian G Hanauer, Stephen B Lémann, Marc Lichtenstein, Gary R Marteau, Phillippe R Reinisch, Walter Sands, Bruce E Yacyshyn, Bruce R Bernhardt, Christian A Mary, Jean-Yves Sandborn, William J |
author_facet | Travis, Simon P L Schnell, Dan Krzeski, Piotr Abreu, Maria T Altman, Douglas G Colombel, Jean-Frédéric Feagan, Brian G Hanauer, Stephen B Lémann, Marc Lichtenstein, Gary R Marteau, Phillippe R Reinisch, Walter Sands, Bruce E Yacyshyn, Bruce R Bernhardt, Christian A Mary, Jean-Yves Sandborn, William J |
author_sort | Travis, Simon P L |
collection | PubMed |
description | BACKGROUND: Variability in endoscopic assessment necessitates rigorous investigation of descriptors for scoring severity of ulcerative colitis (UC). OBJECTIVE: To evaluate variation in the overall endoscopic assessment of severity, the intra- and interindividual variation of descriptive terms and to create an Ulcerative Colitis Endoscopic Index of Severity which could be validated. DESIGN: A two-phase study used a library of 670 video sigmoidoscopies from patients with Mayo Clinic scores 0–11, supplemented by 10 videos from five people without UC and five hospitalised patients with acute severe UC. In phase 1, each of 10 investigators viewed 16/24 videos to assess agreement on the Baron score with a central reader and agreed definitions of 10 endoscopic descriptors. In phase 2, each of 30 different investigators rated 25/60 different videos for the descriptors and assessed overall severity on a 0–100 visual analogue scale. κ Statistics tested inter- and intraobserver variability for each descriptor. A general linear mixed regression model based on logit link and β distribution of variance was used to predict overall endoscopic severity from descriptors. RESULTS: There was 76% agreement for ‘severe’, but 27% agreement for ‘normal’ appearances between phase I investigators and the central reader. In phase 2, weighted κ values ranged from 0.34 to 0.65 and 0.30 to 0.45 within and between observers for the 10 descriptors. The final model incorporated vascular pattern, (normal/patchy/complete obliteration) bleeding (none/mucosal/luminal mild/luminal moderate or severe), erosions and ulcers (none/erosions/superficial/deep), each with precise definitions, which explained 90% of the variance (pR(2), Akaike Information Criterion) in the overall assessment of endoscopic severity, predictions varying from 4 to 93 on a 100-point scale (from normal to worst endoscopic severity). CONCLUSION: The Ulcerative Colitis Endoscopic Index of Severity accurately predicts overall assessment of endoscopic severity of UC. Validity and responsiveness need further testing before it can be applied as an outcome measure in clinical trials or clinical practice. |
format | Online Article Text |
id | pubmed-3292713 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | BMJ Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-32927132012-03-08 Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) Travis, Simon P L Schnell, Dan Krzeski, Piotr Abreu, Maria T Altman, Douglas G Colombel, Jean-Frédéric Feagan, Brian G Hanauer, Stephen B Lémann, Marc Lichtenstein, Gary R Marteau, Phillippe R Reinisch, Walter Sands, Bruce E Yacyshyn, Bruce R Bernhardt, Christian A Mary, Jean-Yves Sandborn, William J Gut Inflammatory Bowel Disease BACKGROUND: Variability in endoscopic assessment necessitates rigorous investigation of descriptors for scoring severity of ulcerative colitis (UC). OBJECTIVE: To evaluate variation in the overall endoscopic assessment of severity, the intra- and interindividual variation of descriptive terms and to create an Ulcerative Colitis Endoscopic Index of Severity which could be validated. DESIGN: A two-phase study used a library of 670 video sigmoidoscopies from patients with Mayo Clinic scores 0–11, supplemented by 10 videos from five people without UC and five hospitalised patients with acute severe UC. In phase 1, each of 10 investigators viewed 16/24 videos to assess agreement on the Baron score with a central reader and agreed definitions of 10 endoscopic descriptors. In phase 2, each of 30 different investigators rated 25/60 different videos for the descriptors and assessed overall severity on a 0–100 visual analogue scale. κ Statistics tested inter- and intraobserver variability for each descriptor. A general linear mixed regression model based on logit link and β distribution of variance was used to predict overall endoscopic severity from descriptors. RESULTS: There was 76% agreement for ‘severe’, but 27% agreement for ‘normal’ appearances between phase I investigators and the central reader. In phase 2, weighted κ values ranged from 0.34 to 0.65 and 0.30 to 0.45 within and between observers for the 10 descriptors. The final model incorporated vascular pattern, (normal/patchy/complete obliteration) bleeding (none/mucosal/luminal mild/luminal moderate or severe), erosions and ulcers (none/erosions/superficial/deep), each with precise definitions, which explained 90% of the variance (pR(2), Akaike Information Criterion) in the overall assessment of endoscopic severity, predictions varying from 4 to 93 on a 100-point scale (from normal to worst endoscopic severity). CONCLUSION: The Ulcerative Colitis Endoscopic Index of Severity accurately predicts overall assessment of endoscopic severity of UC. Validity and responsiveness need further testing before it can be applied as an outcome measure in clinical trials or clinical practice. BMJ Group 2011-10-13 2012-04 /pmc/articles/PMC3292713/ /pubmed/21997563 http://dx.doi.org/10.1136/gutjnl-2011-300486 Text en © 2012, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode. |
spellingShingle | Inflammatory Bowel Disease Travis, Simon P L Schnell, Dan Krzeski, Piotr Abreu, Maria T Altman, Douglas G Colombel, Jean-Frédéric Feagan, Brian G Hanauer, Stephen B Lémann, Marc Lichtenstein, Gary R Marteau, Phillippe R Reinisch, Walter Sands, Bruce E Yacyshyn, Bruce R Bernhardt, Christian A Mary, Jean-Yves Sandborn, William J Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) |
title | Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) |
title_full | Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) |
title_fullStr | Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) |
title_full_unstemmed | Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) |
title_short | Developing an instrument to assess the endoscopic severity of ulcerative colitis: the Ulcerative Colitis Endoscopic Index of Severity (UCEIS) |
title_sort | developing an instrument to assess the endoscopic severity of ulcerative colitis: the ulcerative colitis endoscopic index of severity (uceis) |
topic | Inflammatory Bowel Disease |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3292713/ https://www.ncbi.nlm.nih.gov/pubmed/21997563 http://dx.doi.org/10.1136/gutjnl-2011-300486 |
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