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Marx CE, Schenker C, Xu Y, Salvatore SP, Kahn SR, Garcia D, Delluc A, Kraaijpoel N, Langlois N, Girard P, Le Gal G, Tritschler T. Accuracy and interrater agreement of death event adjudications by physician trainees: validation of the ISTH definition of pulmonary embolism-related death in an autopsy cohort. J Thromb Haemost 2023; 21:2908-2912. [PMID: 37517478 DOI: 10.1016/j.jtha.2023.07.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 07/02/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023]
Abstract
BACKGROUND We previously determined good agreement and high specificity of the International Society on Thrombosis and Haemostasis (ISTH) definition of pulmonary embolism (PE)-related death among an expert central adjudication committee (CAC). CACs are often composed of experts in the corresponding research field. Involving physician trainees in CACs would allow investigators to divide the workload and foster trainees' research experience. OBJECTIVE To evaluate the accuracy of the ISTH definition of PE-related death for PE- versus non-PE-related deaths as confirmed by autopsy and its interrater agreement among physician trainees. METHODS This retrospective autopsy cohort included all patients with PE-related deaths between January 2010 and July 2019 as well as patients who died in 2018 from a cause other than PE at the New York-Presbyterian Hospital. Based on premortem clinical summaries, two physician trainees independently determined the cause of death using the ISTH definition of PE-related death. We calculated the sensitivity and specificity of the ISTH definition to identify autopsy-confirmed PE-related death and its interrater agreement. RESULTS Overall, 126 death events were adjudicated (median age, 68 years; 60 [48%] women), of which 29 (23%) were due to PE, as confirmed by autopsy. Sensitivity and specificity of the ISTH definition for autopsy-confirmed PE-related death was 48% (95% CI, 29-67) and 100% (95% CI, 96-100), respectively. Interrater reliability for PE-related death was good (percentage agreement, 93%; 95% CI, 87-96, Cohen's Kappa, 0.67; 95% CI, 44-85). CONCLUSION Our findings are consistent with our previous validation study. They further support the use of the ISTH definition of PE-related death and revealed high agreement between adjudicators with varied experience.
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Affiliation(s)
- Caterina E Marx
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
| | - Carla Schenker
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Yan Xu
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - Steven P Salvatore
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College/New York-Presbyterian Hospital, New York
| | - Susan R Kahn
- Department of Medicine, McGill University, Montreal, Quebec, Canada; Divisions of Internal Medicine and Clinical Epidemiology, Jewish General Hospital/Lady Davis Institute, Montreal, Canada
| | - David Garcia
- Division of Hematology, Department of Medicine, University of Washington, Seattle
| | - Aurélien Delluc
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - Noémie Kraaijpoel
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Nicole Langlois
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - Philippe Girard
- Institut du Thorax Curie-Montsouris; Institut Mutualiste Montsouris, Paris, France
| | - Grégoire Le Gal
- Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
| | - Tobias Tritschler
- Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
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Crane HM, Heckbert SR, Drozd DR, Budoff MJ, Delaney JAC, Rodriguez C, Paramsothy P, Lober WB, Burkholder G, Willig JH, Mugavero MJ, Mathews WC, Crane PK, Moore RD, Napravnik S, Eron JJ, Hunt P, Geng E, Hsue P, Barnes GS, McReynolds J, Peter I, Grunfeld C, Saag MS, Kitahata MM. The authors reply. Am J Epidemiol 2014; 180:450. [PMID: 24989243 DOI: 10.1093/aje/kwu167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- H M Crane
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - S R Heckbert
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - D R Drozd
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - M J Budoff
- Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095
| | - J A C Delaney
- Department of Epidemiology, School of Public Health, University of Washington, Seattle, WA 98195
| | - C Rodriguez
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - P Paramsothy
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - W B Lober
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - G Burkholder
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - J H Willig
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - M J Mugavero
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - W C Mathews
- Department of Medicine, School of Medicine, University of California, San Diego, San Diego, CA 92093
| | - P K Crane
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - R D Moore
- Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, MD 21205
| | - S Napravnik
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514
| | - J J Eron
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC 27514
| | - P Hunt
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA 94143
| | - E Geng
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA 94143
| | - P Hsue
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA 94143
| | - G S Barnes
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - J McReynolds
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
| | - I Peter
- Department of Medicine, Mount Sinai Medical Center, New York, NY 10029
| | - C Grunfeld
- Department of Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA 94143
| | - M S Saag
- Department of Medicine, School of Medicine, University of Alabama at Birmingham, Birmingham, AL 35294
| | - M M Kitahata
- Department of Medicine, School of Medicine, University of Washington, Seattle, WA 98195
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