Interobserver and intraobserver reliability for 2 grading systems for gastric ulcer syndrome in horses.
Authors: Wise Jessica C, Wilkes Edwina J A, Raidal Sharanne L, Xie Gang, Crosby Danielle E, Hale Josephine N, Hughes Kristopher J
Journal: Journal of veterinary internal medicine
Summary
# Editorial Summary: Reliability of Equine Gastric Ulcer Grading Systems Standardised grading of equine gastric ulcer syndrome (EGUS) underpins clinical decision-making and research comparisons, yet the actual consistency of these assessment tools has remained poorly characterised. Wise and colleagues evaluated how reliably two grading approaches—the established EGUS Council (EGUC) ordinal system and a novel visual analogue scale (VAS)—could be applied by different observers and the same observer on repeated occasions, recruiting six clinicians (three specialists and three residents) to grade 60 gastroscopy videos three times each using a randomised crossover design. The EGUC system demonstrated substantial agreement both between different observers (squamous mucosa AC₂ = 0.69; glandular AC₂ = 0.72) and within individual observers across repeated gradings (squamous AC₂ = 0.80; glandular AC₂ = 0.80), with performance unaffected by observer experience level. By contrast, the VAS showed only moderate interobserver reliability for squamous lesions (ICC = 0.64) and poor agreement for glandular disease (ICC = 0.35), though intraobserver consistency improved with familiarity. For practitioners and researchers making EGUS assessments, this work validates the EGUC system as a dependable standardised tool regardless of individual experience, whilst suggesting that VAS implementation would require substantially more observer training to achieve comparable consistency in clinical or research contexts.
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Practical Takeaways
- •Use the EGUC grading system for EGUS assessment in clinical practice and research, as it provides reliable, consistent results even among less experienced clinicians
- •Visual analog scales require training and experience to achieve consistent results and should not be used as a substitute for the EGUC system without observer standardization
- •Gastroscopic grading of gastric lesions can be reliably performed by both specialists and residents using the EGUC system, reducing barriers to case assessment
Key Findings
- •The EGUC grading system demonstrated substantial interobserver reliability (AC2 = 0.69-0.72) for both squamous and glandular mucosa lesions
- •The EGUC system showed substantial intraobserver reliability (AC2 = 0.80) regardless of observer experience level
- •The novel VAS showed only moderate interobserver reliability for squamous mucosa (ICC = 0.64) and poor reliability for glandular mucosa (ICC = 0.35)
- •Observer experience and familiarity significantly improved VAS reliability but did not affect EGUC system performance