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Equine veterinary journal2020; 53(3); 495-502; doi: 10.1111/evj.13334

Inter-observer variability of two grading systems for equine glandular gastric disease.

Abstract: Equine glandular gastric disease (EGGD) is recognised as a separate entity to equine squamous gastric disease (ESGD) and it is recommended that lesions are graded differently. Currently, no validated scoring system exists for EGGD. Objective: To determine inter-observer reliability of two previously described grading systems for EGGD and to assess if agreement improved with gastroscopy experience, specialist training or familiarity with the descriptive system. Methods: Cross-sectional survey. Methods: A link to an electronic questionnaire containing 20 images of glandular lesions was circulated. Respondents were asked to score lesions using descriptive terminology and a 0-2 verbal rating scale (VRS). Krippendorff's alpha reliability estimate was used to assess inter-rater agreement. A mixed effects model was used to determine which descriptive categories were associated with lesions being described as severe and decision to treat. Results: Eighty-two veterinarians responded, 49 diplomates and 33 non-diplomates. There was no agreement when all four descriptive variables were combined (α = 0.19). Agreement was fair to moderate for severity (α = 0.52), distribution (α = 0.44), appearance (α = 0.38) and shape (α = 0.32). Agreement for the VRS was similar to that for severity (α = 0.53). Agreement was better among diplomates across all categories. Lesion appearance and shape, but not distribution, were associated with both a decision to treat; and lesions being described as severe (P =< .05). A VRS score 2/2 was associated with a lesion being described as severe (OR 75.2, 95% CI 51.12-110.48, P =< .001). Conclusions: Intra-observer variability was not assessed. The number of images is relatively small, and the decision to treat is based on several factors in practice. Conclusions: Overall, agreement for the descriptive system was poor. Better delineation of descriptive category boundaries and characteristics should be determined. Agreement was similar when comparing the severity category and the VRS. Extrapolation to a VRS based on lesion severity may therefore be possible.
© 2020 The Authors. Equine Veterinary Journal published by John Wiley & Sons Ltd on behalf of EVJ Ltd.
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Publication Date: 2020-09-17 PubMed ID: 32808328DOI: 10.1111/evj.13334Google Scholar: Lookup
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Summary

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The research article focuses on the inter-observer reliability of two grading systems used for grading Equine Glandular Gastric Disease (EGGD). The result of the study indicates that the agreement on the descriptive system was poor and suggested that a better definition of descriptive category boundaries and characteristics should be determined.

Objective of the Research

  • The main objective of this research was to investigate the inter-observer reliability of two previously described grading systems used for scoring EGGD. The study aimed to evaluate if familiarity with the descriptive system, specialist training, or gastroscopy experience improved the agreement.

Methodology

  • An electronic questionnaire containing 20 images of glandular lesions was created and circulated. The participants, who were veterinarians, were required to score the lesions using a 0-2 verbal rating scale (VRS) and descriptive terminology.
  • The Krippendorff’s alpha reliability estimate was then used to measure the level of agreement among the scores given by the different observers.
  • A mixed effects model was used to determine which descriptive categories were associated with lesions being described as severe and the decision to treat.

Results

  • There was no agreement when all four descriptive variables were combined.
  • The agreement varied from fair to moderate for severity, distribution, appearance, and shape of the lesions.
  • The study revealed that the agreement for the VRS was similar to that for severity.
  • The level of agreement was higher among diplomates compared to non-diplomates in all categories.
  • Appearance and shape of the lesions, but not their distribution, were associated with a decision to treat and describing lesions as severe.
  • A VRS score of 2/2 was associated with a lesion being described as severe.

Conclusion

  • The research concluded that the overall agreement for the descriptive system was poor, indicating a need for better clarity on descriptive category boundaries and characteristics.
  • The research also suggested the possibility to extrapolate to a verbal rating scale based on lesion severity, given that the agreement was similar for the severity category and the VRS.

Cite This Article

APA
Tallon R, Hewetson M. (2020). Inter-observer variability of two grading systems for equine glandular gastric disease. Equine Vet J, 53(3), 495-502. https://doi.org/10.1111/evj.13334

Publication

Equine veterinary journal
ISSN: 2042-3306
NlmUniqueID: 0173320
Country: United States
Language: English
Volume: 53
Issue: 3
Pages: 495-502

Researcher Affiliations

Tallon, Rose
  • Royal Veterinary College, Hatfield, Hertfordshire, UK.
Hewetson, Michael
  • Royal Veterinary College, Hatfield, Hertfordshire, UK.

MeSH Terms

  • Animals
  • Cross-Sectional Studies
  • Horse Diseases / diagnosis
  • Horses
  • Observer Variation
  • Reproducibility of Results
  • Stomach Diseases / diagnosis
  • Stomach Diseases / veterinary

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Citations

This article has been cited 5 times.
  1. Talbot SE, Tallon R, Dunkel B. Clinical presentation and outcome of gastric impactions with or without concurrent intestinal lesions in horses.. J Vet Intern Med 2023 Jul-Aug;37(4):1544-1551.
    doi: 10.1111/jvim.16735pubmed: 37403262google scholar: lookup
  2. Van Driessche L, Fecteau G, Arsenault J, Miana L, Chorfi Y, Villettaz-Robichaud M, Hélie P, Buczinski S. Inter-Rater Reliability of Scoring Systems for Abomasal Lesions in Q Veal Calves.. Animals (Basel) 2023 May 17;13(10).
    doi: 10.3390/ani13101664pubmed: 37238094google scholar: lookup
  3. Vokes J, Lovett A, Sykes B. Equine Gastric Ulcer Syndrome: An Update on Current Knowledge.. Animals (Basel) 2023 Apr 5;13(7).
    doi: 10.3390/ani13071261pubmed: 37048517google scholar: lookup
  4. Pratt SL, Bowen M, Hallowell GH, Shipman E, Bailey J, Redpath A. Does lesion type or severity predict outcome of therapy for horses with equine glandular gastric disease? - A retrospective study.. Vet Med Sci 2023 Jan;9(1):150-157.
    doi: 10.1002/vms3.1034pubmed: 36495212google scholar: lookup
  5. Pratt S, Bowen I, Hallowell G, Shipman E, Redpath A. Assessment of agreement using the equine glandular gastric disease grading system in 84 cases.. Vet Med Sci 2022 Jul;8(4):1472-1477.
    doi: 10.1002/vms3.807pubmed: 35412651google scholar: lookup
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