Abstract
Thyroid eye disease (TED) can be difficult to manage. The range of available treatments is expanding rapidly, however cost is a concern and some patients do not respond. The Clinical Activity Score (CAS) was devised as a measure of disease activity and a potential predictor of response to anti-inflammatory treatment. Despite its widespread use, inter-observer variability of CAS has not been investigated. The aim of the study was to determine the inter-observer variability of CAS in patients with TED. Prospective reliability analysis METHODS: Nine patients with a spectrum of clinical features of TED were assessed by 6 experienced observers on the same day. The agreement between the observers were analysed using Krippendorff alpha. The Krippendorff alpha for the total CAS score was 0.532 (95% confidence interval (CI) 0.199-0.665), while alpha values for the individual components of CAS varied between 0.171 (CI 0.000-0.334) for lid redness and 0.671 (CI 0.294-1.000) for spontaneous pain. Assuming that a CAS ≥3 implies suitability of the patient for anti-inflammatory treatment, the calculated Krippendorff's alpha for agreement between assessors on whether treatment should be given or not, was 0.332 (95% CI 0.0011-0.5862). This study has shown unreliable inter-observer variability in total CAS and most individual CAS components, thus highlighting the need for improving the performance of CAS, or seeking other methods to assess activity.
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