비내시경을 활용한 알레르기 비염에 대한 한의학적 변증 지표의 관찰자간, 관찰자내 신뢰도 연구

Abstract

Objectives : We performed a pilot study to investigate inter- and intra-rater reliability of pattern identification using nasal endoscopy for allergic rhinitis(AR). Methods : Eight experts of ophthalmology, otolaryngology and dermatology of Korean medicine evaluated 20nasal endoscopy photograph cases of AR patients with pattern identification index using nasal endoscopy for AR including the nasal membrane color(pale / hyperemia), nasal membrane humidity(dryness / dampness),rhinorrhea(watery / yellow), and membrane edema (atrophic / edematous) on nasal endoscopy. Results : Intra-rater agreement(%) and Kappa coefficient was generally from 'moderate' to 'good'(% agreement:73.13-90% / Kappa coefficient: 0.547-0.748). Inter-rater agreement(%) and Kappa coefficient was also from 'moderate' to 'good' (% agreement: 65-85% / Kappa: 0.475-0.778) except 'humidity(dryness / dampness)' item (%agreement: 55.98% / Kappa: 0.340). In findings of subgroup analysis according to affiliation of raters, Inter-rater agreement(%) and Kappa coefficient of raters in same affiliation was higher than inter-rater agreement(%) and Kappa coefficient of raters in different affiliation except 'dryness / dampness' item. Conclusions : It is necessary to improve objectivity and reproducibility of pattern identification using nasal endoscopy for allergic rhinitis(AR) through the development of detail-oriented criteria and enhanced training of clinicians with development of standard operating procedures(SOPs).