Interobserver Variation in the Diagnosis of Neurologic Abnormalities in the Horse.
Abstract: The diagnosis of equine protozoal myeloencephalitis (EPM) relies heavily on the clinical examination. The accurate identification of neurologic signs during a clinical examination is critical to the interpretation of laboratory results. Objective: To investigate the level of agreement between board-certified veterinary internists when performing neurologic examinations in horses. Methods: Ninety-seven horses admitted to the Veterinary Teaching Hospital at The Ohio State University from December 1997 to June 1998. Methods: A prospective epidemiologic research design was used. Horses enrolled in the study were examined by the internist responsible for care of the horse, and later by an internist who was not aware of the presenting complaint or other patient history. Data were analyzed by descriptive statistics, and kappa (K) statistics were calculated to assess interobserver agreement. Results: Ninety-seven horses were enrolled in the study. Overall, examiners, also referred to as observers, agreed that 60/97 (61.9%) were clinically abnormal, 21/97 (21.6%) were clinically normal, and the status of 16/97 (16.5%) of horses was contested. There was complete agreement among the examiners with regard to cranial nerve signs and involuntary movements. Disagreement involving severity of clinical signs occurred in 31 horses, and 25 of those horses (80.6%) were considered either normal or mildly affected by the primary observer. When examining the results of all paired clinical examinations for 11 different categories, there was wide variability in the results. When examiners rated the presence or absence of any neurologic abnormalities, lameness, or ataxia, the agreement among observers was either good or excellent for 80% of horses. When assessing truncal sway, the agreement among observers was good or excellent for 60% of the horses. When examining the horses for asymmetry of deficits, agreement was either good or excellent for 40% of the horses. Agreement among observers was excellent or good for only 20% of the horses when assessing muscle atrophy, spasticity (hypermetria), and overall assessment of the severity of neurologic abnormalities. Conclusions: This study underscores the subjectivity of the neurologic examination and demonstrates a reasonable level of agreement that may be achieved when different clinicians examine the same horse.
Copyright © 2017 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.
Publication Date: 2017-09-09 PubMed ID: 28887894PubMed Central: PMC5697190DOI: 10.1111/jvim.14822Google Scholar: Lookup
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- Journal Article
- Clinical Examination
- Clinical Findings
- Clinical Pathology
- Clinical Signs
- Clinical Study
- Diagnosis
- Disease Diagnosis
- Equine Diseases
- Equine Health
- Equine Protozoal Myeloencephalitis
- Equine Science
- Horses
- Neurological Diseases
- Neurology
- Observational Study
- Veterinary Care
- Veterinary Medicine
- Veterinary Practice
- Veterinary Procedure
- Veterinary Research
- Veterinary Science
Summary
This research summary has been generated with artificial intelligence and may contain errors and omissions. Refer to the original study to confirm details provided. Submit correction.
The research focuses on measuring the level of agreement between different veterinary experts when diagnosing neurological conditions in horses, specifically equine protozoal myeloencephalitis (EPM). The results show that, although there is a fair level of agreement, the diagnostic process has a degree of subjectivity, which can result in variability in the diagnostic outcomes.
Methods and Sample
- The study ran a prospective epidemiologic research design involving 97 horses admitted to The Ohio State University’s Veterinary Teaching Hospital between December 1997 and June 1998.
- Each horse was examined by two internists – the one in charge of its care, and another who was not privy to the horse’s medical history or initial complaint. This process ensured that the second examination was unbiased and independent.
- Data was analyzed using descriptive statistics, and kappa statistics were employed to assess the level of interobserver agreement.
Research Findings
- Out of 97 horses, the examiners concurred that 60 horses were clinically abnormal, 21 were normal, and they disputed over the condition of 16 horses.
- There was complete agreement when it came to diagnosing cranial nerve signs and involuntary movements.
- The most disagreements stemmed from assessing the severity of clinical signs, with 31 horses causing a difference in opinion. In these cases, the majority were considered either normal or mildly affected by the first observer.
Interobserver Agreement Examination
- The researchers found a varying degree of diagnostic agreement based on different clinical examinations. For instance, 80% of the horses received consistent diagnoses when the examiners were assessing the presence of any neurological abnormalities, lameness, or ataxia.
- The degree of interobserver agreement went down to 60% when looking at truncal sway, and fell further to 40% when checking for asymmetry of deficits.
- The lowest level of agreement was seen when evaluating muscle atrophy, spasticity or hypermetria, and overall severity of neurological abnormalities, with only 20% of the horses receiving consistent diagnoses.
Conclusions
- The study highlighted the subjective nature of the neurological examination process in horses. It pointed out how different clinicians examining the same horse can reach different diagnostic outcomes.
- Even though there is a notable variance in their findings, the study establishes a reasonable level of agreement that clinicians can potentially achieve when diagnosing horses for EPM or similar neurological conditions.
Cite This Article
APA
Saville WJA, Reed SM, Dubey JP, Granstrom DE, Morley PS, Hinchcliff KW, Kohn CW, Wittum TE, Workman JD.
(2017).
Interobserver Variation in the Diagnosis of Neurologic Abnormalities in the Horse.
J Vet Intern Med, 31(6), 1871-1876.
https://doi.org/10.1111/jvim.14822 Publication
Researcher Affiliations
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH.
- Rood and Riddle Equine Hospital, Lexington, KY.
- United Sates Department of Agriculture, Agricultural Research Service, Beltsville Agricultural Research Center, Animal Parasitic Diseases Laboratory, Beltsville, MD.
- American Veterinary Medical Association, Schaumburg, IL.
- Colorado School of Public Health, James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, CO.
- Faculty of Veterinary and Agricultural Sciences, University of Melbourne, Parkville, Vic, Australia.
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State University, Columbus, OH.
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH.
- Department of Veterinary Preventive Medicine, College of Veterinary Medicine, The Ohio State University, Columbus, OH.
MeSH Terms
- Animals
- Ataxia / diagnosis
- Ataxia / veterinary
- Coccidiosis / veterinary
- Dyskinesias / diagnosis
- Dyskinesias / veterinary
- Encephalomyelitis / diagnosis
- Encephalomyelitis / parasitology
- Encephalomyelitis / veterinary
- Horse Diseases / diagnosis
- Horses
- Nervous System Diseases / diagnosis
- Nervous System Diseases / veterinary
- Observer Variation
- Physical Examination / standards
- Physical Examination / veterinary
- Prospective Studies
- Reproducibility of Results
- Sarcocystosis / veterinary
Conflict of Interest Statement
Kenneth W. Hinchcliff serves as Co‐Editor in Chief for the Journal of Veterinary Internal Medicine. He was not involved in review of this manuscript.
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This article includes 16 references
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Citations
This article has been cited 4 times.- van Spijk JN, Beckmann K, Wehrli Eser M, Stirn M, Steuer AE, Saleh L, Schoster A. Preliminary Investigation of Side Effects of Polymyxin B Administration in Hospitalized Horses. Antibiotics (Basel) 2023 May 5;12(5).
- van Spijk JN, Beckmann K, Wehrli Eser M, Boxler M, Stirn M, Rhyner T, Kaelin D, Saleh L, Schoster A. Adverse effects of polymyxin B administration to healthy horses. J Vet Intern Med 2022 Jul;36(4):1525-1534.
- Bedenice D, Johnson AL. Neurologic conditions in the sport horse. Anim Front 2022 Jun;12(3):37-44.
- Rijckaert J, Raes E, Buczinski S, Dumoulin M, Deprez P, Van Ham L, van Loon G, Pardon B. Accuracy of transcranial magnetic stimulation and a Bayesian latent class model for diagnosis of spinal cord dysfunction in horses. J Vet Intern Med 2020 Mar;34(2):964-971.
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