Doppler Color Scoring System in Women With an Incomplete MiscarriageInterobserver and Intraobserver Reproducibility Study

Authors Organisations
  • Grace Ting Ting Leong(Author)
    University of Sydney Nepean Hospital
  • Mathew Leonardi(Author)
    University of Sydney Nepean Hospital
  • Chuan Lu(Author)
  • Brendan Mein(Author)
    University of Sydney Nepean Hospital
  • Mercedes Espada(Author)
    University of Sydney Nepean Hospital
  • Babak Shakeri(Author)
    University of Sydney Nepean Hospital
  • Batool Nadim(Author)
    University of Sydney Nepean Hospital
  • Shannon Reid(Author)
    Wollongong Hospital
  • Ishwari Casikar(Author)
    University of Sydney Nepean Hospital
  • George Condous(Author)
    University of Sydney Nepean Hospital
Type Article
Original languageEnglish
Pages (from-to)2437-2445
Number of pages9
JournalJournal of Ultrasound in Medicine
Volume38
Issue number9
Early online date29 Jan 2019
DOI
Publication statusPublished - 01 Sep 2019
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Abstract

Objectives
Doppler Color Scoring (DCS) has been used to predict successful expectant management of incomplete miscarriage. The aim of this study was to assess inter‐ and intraobserver reproducibility of the DCS system in women with incomplete miscarriage noted on transvaginal sonography.

Methods
This was a prospective reproducibility study involving offline analysis of 32 prerecorded video sets on transvaginal sonography in real time of women with incomplete miscarriage. Vascularization of retained products of conception was recorded using the DCS system adopted from the International Ovarian Tumor Analysis group. Five gynecologic sonologists of varying experience assigned a DCS classification to each video in the analysis. The same videos were reanalyzed, in a different order, at least 7 days later, to assess intraobserver agreement. Inter‐ and intraobserver correlations were performed to determine agreement. Interobserver agreement was also measured between each observer and the reference standard (G.C.). A Cohen's κ coefficient value less than 0 suggests poor agreement, 0.01 to 0.20 slight, 0.21 to 0.40 fair, 0.41 to 0.60 moderate, 0.61 to 0.80 substantial, and 0.81 and 0.99 almost perfect.

Results
Interobserver agreement for all observers for DCS allocation ranged from 0.480 to 0.751. Overall interobserver agreement for 5 observers was substantial (κ, 0.626). Overall interobserver agreements for the 2 inexperienced and 3 experienced observers compared to G.C. were 0.521 and 0.618, respectively. Experienced observers achieved overall almost perfect intraobserver agreement, compared to substantial agreement for inexperienced sonologists.

Conclusions
DCS interobserver reproducibility between all observers and GC ranged from moderate to substantial. DCS intraobserver reproducibility was substantial to almost perfect. The DCS system appears to be a reproducible tool in evaluating women with incomplete miscarriage

Keywords

  • color, first trimester, gynecology, imcomplete miscarriage, observer variation, patient care, prospective studies, reproducibility of results, retained products of conception, sonography