Intersystem Agreement Research Articles

Comparison between local and three validated triage systems in an emergency department for 2126 children under 3 months.

Triage of patients less than 3 months old was not already studied. The aim was to evaluate Paediatric Emergency Department triage in patients less than 3 months old and newborns using a local system in comparison with three validated paediatric triage systems (Canadian Triage and Acuity Scale, Manchester Triage System and Emergency Severity Index) and to determine inter-system agreement. All admissions of patients less than 3 months old admitted to the Emergency Department of the Saint Vincent University Hospital between April 2018 and December 2019 were included. The local triage system level was determined prospectively for comparison with retrospectively calculated triage levels of the validated systems. Hospitalisation rates were compared and inter-system agreements determined. Among emergency admissions, 2126 were included (55% males, mean age 45 days). Hospitalisation rate increased with priority severity as determined by all triage systems studied. Cohen's kappa showed slight agreement between the local triage system and the Canadian Triage and Acuity Scale, Emergency Severity Index and Manchester Triage System (weighted kappa = 0.133, 0.185 and 0.157 respectively). Whether prospective or retrospective triage used, the systems studied exhibited good association with hospitalisation rate for patients aged less than 3 months and newborn infants.

Differences between Systems Using Optical and Capacitive Sensors in Treadmill-Based Spatiotemporal Analysis of Level and Sloping Gait

Modern technology has enabled researchers to analyze gait with great accuracy and in various conditions based on the needs of the trainees. The purpose of the study was to investigate the agreement between systems equipped with optical and capacitive sensors in the analysis of treadmill-based level and sloping gait. The spatiotemporal parameters of gait were measured in 30 healthy college-level students during barefoot walking on 0% (level), −10% and −20% (downhill) and +10% and +20% (uphill) slopes at hiking-related speeds using an optoelectric cell system and an instrumented treadmill. Inter-system agreement was assessed using the Intraclass Correlation Coefficients (ICCs) and the 95% limits of agreement. Our findings revealed excellent ICCs for the temporal and between moderate to excellent ICCs for the spatial parameters of gait. Walking downhill and on a 10% slope demonstrated better inter-system agreement compared to walking uphill and on a 20% slope. Inter-system agreement regarding the duration of gait phases was increased by increasing the number of LEDs used by the optoelectric cell system to detect the contact event. The present study suggests that systems equipped with optical and capacitive sensors can be used interchangeably in the treadmill-based spatiotemporal analysis of level and sloping gait.

Evaluation of the Onclarity HPV assay on the high-throughput COR system

ABSTRACT Background: Here we compare the performance of the high-throughput BD COR System (COR) to the Viper LT System (Viper) using the BD Onclarity HPV assay. Research Design and Methods: Remnant clinical specimens, contrived specimens in SurePath (BD) and PreservCyt (Hologic) media, and prospective clinical specimens in BD Cervical Brush Diluent (CBD) were tested. Outcomes included intra-laboratory agreement of Onclarity results on COR and inter-system agreement between COR and Viper. Results: Onclarity reproducibility on COR resulted in standard deviation and correlation of variation of Ct values ranging from 0.14 to 1.98 and 0.49% to 2.15%, respectively, for contrived specimens, and 0.9–3.08 and 2.89–9.21%, respectively, for clinical specimens. In the COR and Viper clinical agreement study, OPA for Onclarity ranged from 97.1%-98.9%, depending on the collection media type. PPA values for pooled, HPV(+) specimens at low positive (C95), and moderate positive (3XC95) target concentrations were ≥95.0% and 100%, respectively; PPA values associated with HPV 16, 18, 31, 45, 33/58, 52, 35/39/68, 51, and 56/59/66, individually, ranged from 93.8%-100%. Conclusions: Onclarity performance on COR is equivalent to Viper, and is accurate and reproducible for detection of all high-risk HPV genotypes, with a throughput of 330 results from a single 8-hour shift.

COVID-19 computed tomography reporting systems: inter-rater and inter-system agreement study

Aim: The aim of this study was to investigate agreements between COVID-19 reporting systems and radiologists. Materials and Methods: A total of 100 laboratory-confirmed COVID-19 cases (49 males, 51 females;age range 19-88 years) were retrospectively collected. Firstly, computed tomography (CT) images were evaluated by two radiologists independently and blinded to clinical notes and laboratory and radiological reports and they gave their impressions independently according to four COVID-19 reporting systems, then all CTs were interpreted again by the two radiologists for extracting CT features at the same session by consensus. Results: Bilateral, lower lobe, peripheral, dorsal and multifocal lung involvements were predominantly seen, and ground-glass opacities (GGOs) were the most common CT imaging finding in the current study. Reporting systems showed fair to moderate agreements between senior and junior raters (0.246-0.490, p<0.001). According to the assigned three-category coding system as similar to that of the Radiological Society of North America (RSNA) Expert Consensus Statement on Reporting and other reporting systems and guidance, strength of inter-rater agreement values was increased (0.365-0.576, p<0.001) and inter-system agreements were substantial to almost perfect in both raters. Conclusion: Radiology reporting including frequently seen CT features and lung parenchyma distributions with systems based on fewer categories may provide good agreement between observers in patients with suspected COVID-19. [ABSTRACT FROM AUTHOR] Copyright of Annals of Medical of Research is the property of Annals of Medical Research and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Repeatability and Agreement of Shear Wave Speed Measurements in Phantoms and Human Livers Across 6 Ultrasound 2-Dimensional Shear Wave Elastography Systems.

Ultrasound shear wave elastography (SWE) is an imaging technique that quantifies liver stiffness. However, comparison data across newest ultrasound systems are sparse. The purpose of this study was to assess repeatability and agreement of shear wave speeds (SWSs) across 6 ultrasound 2-dimensional (2D) SWE systems. This cross-sectional, Health Insurance Portability and Accountability Act-compliant study received institutional review board approval. Written informed consent was obtained. Serial 2D SWE examinations were performed with 6 ultrasound systems (Aplio i800, Canon Medical Systems; LOGIQ E10, GE Healthcare; Resona 7, Mindray North America; EPIQ Elite, Philips Healthcare; ACUSON Sequoia, Siemens Medical Solutions; and Aixplorer MACH 30, SuperSonic Imagine) on 4 elastic phantoms (SWS range, 0.82-3.51 m/s) and on livers of 24 adults (healthy volunteers and patients with known liver stiffening). Participants were imaged 2 times per ultrasound system, with 90 to 120 minutes between examinations. Median SWS was calculated from separately acquired SWS measurements per examination (40 phantom measurements and 10 liver measurements per examination). Overall intraclass correlation coefficient (ICC) for intersystem agreement of median SWS across systems was 0.99 (95% confidence interval, 0.96-1.0) in phantoms and 0.66 to 0.69 (95% confidence interval, 0.47-0.84) in humans across systems. Means of median SWS measurements in humans ranged from 1.24 to 1.56 m/s. Average individual subject-level variance (interquartile range/median SWS) across all examinations was 0.07, with an average coefficient of variation of 6.0%. Pairwise ICCs for intersystem agreement in subjects across systems ranged from 0.41 to 0.91; test-retest repeatability in subjects was excellent for all systems, with ICCs ranging from 0.87 to 0.97. There is good to excellent intersystem agreement of measured SWS in elastic phantoms and in vivo livers across 6 ultrasound 2D SWE systems. Test-retest repeatability was excellent for all systems.

The Correlation between Facial Nerve Grading System 2.0 and the Sunnybrook Facial Grading System in Subjects with Facial Palsy: A Cross-Sectional Study

Introduction: Over many years, several methods have been developed to evaluate the facial nerve palsy. Among them, Sunnybrook Facial Grading System (SFGS) and modified House-Brickmanne, known as Facial Nerve Grading System 2.0 (FNGS 2.0), grading systems have been the most favored methods to evaluate facial nerve health between therapists and researchers. The aim of this study was to compare these two evaluation approaches. Materials and Methods: In the present cross-sectional study, the videotapes for nineteen subjects diagnosed with facial nerve palsy were recorded before and after treatment. Then, the videotapes were evaluated using the SFGS and FNGS 2.0 scales by three specialists separately. The inter-rater agreement was reported using Intraclass correlation coefficient (ICC) scores. The correlation between the two evaluation approaches was determined using Spearman’s coefficient of correlation. Results: The ICC score for scoring by the specialists was 0.969 for SFGS and 0.904 for FNG 2.0. The FNG 2.0 and SFGS inter-system agreement reported as 0.848 (P < 0.01). The coefficient was higher before treatment (0.961), and decreased after treatment (0.777). Conclusion: Although the correlation between two systems was acceptable, the SFGS system was more sensitive than FNG 2.0.

New imaging markers for preconceptional and first-trimester utero-placental vascularization

IntroductionThe availability of imaging makers of early placental circulation development is limited. This study aims to develop a feasible and reliable method to assess preconceptional and early first-trimester utero-placental vascular volumes using three-dimensional power Doppler (3D PD) ultrasound on two different Virtual Reality (VR) systems. Methods3D PD ultrasound images of the uterine and placental vasculature were obtained in 35 women, either preconceptionally (n = 5), or during pregnancy at 7 (n = 10), 9 (n = 10) or 11 (n = 10) weeks of gestation. Preconceptional uterine vascular volume (UVV), first-trimester placental vascular volume (PVV) and embryonic vascular volume (EVV) were measured by two observers on two VR systems, i.e., a Barco I-Space and VR desktop. Intra- and inter-observer agreement and intersystem agreement were assessed by intra-class correlation coefficients (ICC) and absolute and relative differences. ResultsUterine-, embryonic- and placental vascular volume measurements showed good to excellent intra- and inter-observer agreement and inter-system reproducibility with most ICC above 0.80 and relative differences of less than 20% preconceptionally and almost throughout the entire gestational age range. Inter-observer agreement of PVV at 11 weeks gestation was suboptimal (ICC 0.69, relative difference 50.1%). DiscussionPreconceptional and first-trimester 3D PD ultrasound utero-placental and embryonic vascular volume measurements using VR are feasible and reliable. Longitudinal cohort studies with repeated measurements are needed to further validate this and assess their value as new imaging markers for placental vascular development and ultimately for the prediction of placenta-related pregnancy complications.

Predictive models for mortality after ruptured aortic aneurysm repair do not predict futility and are not useful for clinical decision making

ObjectiveThe clinical decision-making utility of scoring algorithms for predicting mortality after ruptured abdominal aortic aneurysms (rAAAs) remains unknown. We sought to determine the clinical utility of the algorithms compared with our clinical decision making and outcomes for management of rAAA during a 10-year period. MethodsPatients admitted with a diagnosis rAAA at a large university hospital were identified from 2005 to 2014. The Glasgow Aneurysm Score, Hardman Index, Vancouver Score, Edinburgh Ruptured Aneurysm Score, University of Washington Ruptured Aneurysm Score, Vascular Study Group of New England rAAA Risk Score, and the Artificial Neural Network Score were analyzed for accuracy in predicting mortality. Among patients quantified into the highest-risk group (predicted mortality >80%-85%), we compared the predicted with the actual outcome to determine how well these scores predicted futility. ResultsThe cohort comprised 64 patients. Of those, 24 (38%) underwent open repair, 36 (56%) underwent endovascular repair, and 4 (6%) received only comfort care. Overall mortality was 30% (open repair, 26%; endovascular repair, 24%; no repair, 100%). As assessed by the scoring systems, 5% to 35% of patients were categorized as high-mortality risk. Intersystem agreement was poor, with κ values ranging from 0.06 to 0.79. Actual mortality was lower than the predicted mortality (50%-70% vs 78%-100%) for all scoring systems, with each scoring system overestimating mortality by 10% to 50%. Mortality rates for patients not designated into the high-risk cohort were dramatically lower, ranging from 7% to 29%. Futility, defined as 100% mortality, was predicted in five of 63 patients with the Hardman Index and in two of 63 of the University of Washington score. Of these, surgery was not offered to one of five and one of two patients, respectively. If one of these two models were used to withhold operative intervention, the mortality of these patients would have been 100%. The actual mortality for these patients was 60% and 50%, respectively. ConclusionsClinical algorithms for predicting mortality after rAAA were not useful for predicting futility. Most patients with rAAA were not classified in the highest-risk group by the clinical decision models. Among patients identified as highest risk, predicted mortality was overestimated compared with actual mortality. The data from this study support the limited value to surgeons of the currently published algorithms.

Comparative study to evaluate the intersystem association and reliability between standard pelvic organ prolapse quantification system and simplified pelvic organ prolapse scoring system.

The purpose of this study was to determine the association between the standard pelvic organ prolapse quantification (POPQ) classification system and the simplified pelvic organ prolapse (S-POP) classification system. This is an observational study, in which 100 subjects, whose average age was 60±10years, with pelvic floor disorder symptoms underwent two systems of examinations-POPQ classification system and S-POP classification system at Safdarjung hospital-done by four gynecologists (two specialists and two resident doctors) using a prospective randomized study, blinded to each other's findings. Data were compared using appropriate statistics. The weighted Kappa statistics for the intersystem reliability of the S-POP classification system compared with standard POPQ classification system were 0.82 for the overall stage: 0.83 and 0.86 for the anterior and posterior vaginal walls respectively; 0.81 for the apex/vaginal cuff; and 0.89 for the cervix. All these results demonstrate significant agreement between the two systems. There is almost perfect intersystem agreement between the S-POP classification system and the standard POPQ classification system in respect of the overall stage as well as each point within the same system.

Left and right ventricular strain and strain rate measurement in normal adults using velocity vector imaging: an assessment of reference values and intersystem agreement

Velocity vector imaging (VVI) software permits quantitative assessment of ventricular function through measurement of myocardial strain (S) and strain rate (SR). The purpose of this study was to define a reference range of ventricular S and SR values in normal adults using VVI software, and to describe the variability among observers and systems. Two-dimensional echocardiography was performed in 186 healthy adults free of cardiovascular disease or risk factors, followed by comprehensive ventricular S and SR analysis using VVI software. Images were acquired using three commercial ultrasound systems. The mean age of patients was 44 ± 16 years, and 114 (61 %) were female. Mean global left ventricular (LV) longitudinal, circumferential, and radial S and SR, and right ventricular (RV) longitudinal S and SR values are presented. Significant segmental variation in regional LV and RV S and SR was detected. Multivariate regression analysis demonstrated global longitudinal LV (p = 0.05) and RV (p = 0.002) S values decline significantly with age. The overall variability of S and SR values accounted for by patient demographic and hemodynamic variables was low (16 and 8 % for LV longitudinal S and SR, respectively). Interobserver agreement was very good, but was lowest for LV radial S and SR. There were no significant differences of LV and RV S and SR between ultrasound systems. Comprehensive reference values for the normal ranges of LV and RV S and SR measured using VVI software are presented. The ultrasound system used for image acquisition did not significantly influence results.

Facial Nerve Grading 2.0 and Sunnybrook Facial Grading System

Objective: We aim to measure the intra-system reliability and the inter-system agreement between the Facial Nerve Grading 2.0 and Sunnybrook Facial Grading system (SFGS). Method: Video clips of 12 patients with facial nerve dysfunction performing a protocol of facial expressions were recorded. Thirteen physicians were asked to evaluate the videos independently using the 2 scales. Results: The ICC score for FNG 2.0 and SFGS was 0.820 (95% CI=0.677-0.931) and 0.831 (95% CI=0.696-0.936), respectively. The FNG 2.0 and SFGS inter-system agreement ICC score was 0.959 (95% CI=0.944-0.970). Conclusion: Studies have established high intra-system reliability for the SFGS, and our results corroborate these. FNG 2.0 similarly shows high intra-system reliability. As the inter-system agreement was found to be near perfect in our study, the new FNG 2.0 should be considered as an alternative grading scale for facial nerve palsy.

Average 3-Dimensional Models for the Comparison of Orbscan II and Pentacam Pachymetry Maps in Normal Corneas

To assess the reliability of Orbscan (Bausch & Lomb, Salt Lake City, UT) and Pentacam (Oculus, Wetzlar, Germany) central corneal thickness (CCT) and peripheral corneal thickness (PCT) measurements based on 2 methodologies. Evaluation of a diagnostic technology. Thirty healthy volunteers were recruited prospectively at the Department of Ophthalmology of the Hôtel-Dieu Hospital, Paris, France. Central corneal thickness and PCT were assessed, using ultrasound pachymetry (USP) as the gold standard. Two methodologies were used: (1) the traditional analysis of pachymetry data from 1 central and 8 peripheral reference positions on the cornea, and (2) a 3-dimensional (3-D) analysis based on average corneal pachymetry maps constructed for each system (Orbscan, Pentacam, and USP), each operator (operators 1 and 2), and each visit (visits A and B). Repeatability, intersystem reproducibility, interoperator reproducibility, reproducibility over time, and accuracy of Orbscan and Pentacam CCT and PCT measurements. Distribution and statistical significance of the differences between 3-D average maps. Repeatability (Orbscan intraclass correlation coefficients [ICCs], 0.967-0.992; Pentacam ICCs, 0.986-0.997), interoperator reproducibility, and reproducibility over time (ICCs, 0.976-0.997) were excellent to almost perfect for both systems. Intersystem agreement was almost perfect for CCT (ICC, 0.980), but less strong for PCT (ICCs, 0.928-0.979). Despite a good to excellent agreement between the optical systems and USP (ICCs, 0.608-0.958), USP CCT readings were thicker (mean difference, up to 15.2 microm; P<0.05), and USP PCT readings were thinner (P<0.05). Orbscan and Pentacam average maps allowed comprehensive interpretation of differences between populations according to the magnitude, distribution, and statistical significance, minimizing the risk of giving excessive weight to few data measured at specific locations on the cornea. Both methodologies showed that Orbscan and Pentacam CCT readings are interchangeable, whereas caution should be used for PCT readings. Interchangeability with USP measurements also was shown to be limited. The high repeatability, interoperator reproducibility, reproducibility over time, the extent of the information generated by a single capture, and the noncontact nature of the Orbscan and Pentacam all suggest that optical systems eventually may replace USP as the gold standard for corneal pachymetry.

Validation of a simplified technique for using the POPQ pelvic organ prolapse classification system

Our objective was to determine the inter-examiner agreement of a simplified pelvic organ prolapse quantification (POPQ) exam and to assess its correlation with the standard POPQ exam. This study consists of two parts; both were performed in a prospective, randomized, blinded fashion on women presenting with complaints attributed to pelvic organ support defects. The first study was done to determine the inter-examiner reliability of a simplified POPQ exam. The simplified POPQ exam is based on the POPQ with similar ordinal staging but with only four points measured instead of nine. Forty-eight women underwent exams by five different investigators. The order of exams was randomized and the examiners were blinded to the results of each other's findings. The results of these two exams were compared using weighted kappa statistics. The second part of the study was done to determine the inter-system agreement between the simplified vs standard POPQ exam. A group of 49 women were examined by four different investigators: one using the simplified and the other using standard POPQ exams. The order of the exams was randomized and the examiners were blinded to the results of each other's exam. Kendall's tau-b statistics were used to determine the inter-system agreement. For the inter-examiner reliability of the POPQ exam, the average age was 60+/-13 years. The weighted kappa statistics for the inter-examiner reliability of the simplified prolapse classification system were 0.86 for the overall stage, 0.89 and 0.86 for the anterior and posterior vaginal walls, respectively, 0.82 for the apex/cuff, and 0.72 for the cervix. All demonstrate significant agreement. For the inter-system association between the simplified POPQ and standard POPQ, the average age was 61+/-15 year. The Kendall's tau-b value for overall stage was 0.90, 0.83, and 0.87 for the anterior and posterior walls respectively, and 0.78 for the cuff/apex and 0.98 for the cervix. There is good inter-examiner agreement of a simplified POPQ classification system and it appears to have good inter-system association with the POPQ.

Interobserver Agreement and Intersystem Comparison of the Halfway System of Baden and Walker Versus the Pelvic Organ Prolapse???Quantitation Prolapse Classification System in Assessing the Severity of Pelvic Organ Prolapse

AbstractObjective:The objective of this study was to assess the interobserver and intersystem agreement of the Baden and Walker (B&W) and the Pelvic Organ Prolapse–Quantitation (POP-Q) systems.Methods:Fifty patients with primo pelvic organ prolapse were consecutively examined by 2 gynecologists acco

Comparison of Signal‐Averaging Electrocardiographic Systems Using Device Specific Criteria in 104 Normal Subjects

The advent of several signal-averaged electrocardiogram (SAECG) systems for late potential (LP) assessment warrants comparisons to assess intersystem reproducibility and variability. Simultaneous SAECGs on two systems, Arrhythmia Research Technology (ART) and Marquette (MEI), were performed on 104 normal volunteers (53 males, age 44 +/- 14 years), and analyzed filtered QRS duration (TFQRS), root mean square voltage (RMS40), and low amplitude signal duration (LAS40), filtered at 40-250 Hz. The Gomes criteria (TfQRS > 114 msec, RMS40 < 20 microV and LAS40 > 38 msec) were used as criteria for LP. The data was also analyzed using the recently proposed system specific criteria for MEI (TFQRS > 120 msec, RMS40 < 20 microV and LAS40 > 38 msec). Where appropriate, statistical analysis was performed using simple linear and Spearman's rank correlation, analysis of variance, Finn's R and McNemar's test. The means +/- SD for ART and MEI were: TFQRS: 97.2 +/- 8.9 vs 108.2 +/- 7.2 msec (R = 0.76), RMS40: 31.8 +/- 17.8 vs 45.3 +/- 19.9 microV (R = 0.53), and LAS40: 32.2 +/- 8.4 vs 30 +/- 7.4 (R = 0.54). When the Gomes criteria were applied, the number of subjects identified by each system as abnormal were: TFQRS = 3 vs 22 (P < 0.001), RMS40 = 20 vs 8 (P = 0.004), LAS40 = 21 vs 9 (P = 0.004), TFQRS/RMS40 = 3 vs 6 (P = 0.38), TFQRS/LAS40 = 3 vs 7 (P = 0.22), RMS40/LAS40 40 = 17 vs 8 (P = 0.02), and all three criteria = 3 vs 6 (P = 0.38) for ART vs MEI, respectively. Percent agreement was 81.7% for TFQRS and 84.6% for RMS40 and LAS40 when single criteria were applied. Agreement improved when combined criteria were utilized (87.5%-95.2% for any two criteria and 95.2% for all three criteria). The intersystem agreement that was not due to chance was 0.63-0.69 for single criteria and 0.75-0.90 for combined criteria. Disagreement was highly significant for the three criteria when used singly and for RMS40 and LAS40 combined. Disagreement was not significant when TFQRS was used in combination with > or = one other criteria. When the MEI criteria were applied, there was a decrease in the number of subjects identified by the MEI system as abnormal, using the TFQRS criteria singly or in combination. Percent agreement for system specific TFQRS measurements was 94.2% for single criteria and 97.1% for combined criteria. The intersystem agreement that was not due to chance improved (88-0.94). Disagreement between system specific criteria for TFQRS was not significant (P > 0.05). Our data indicate that although there is a general correlation between ART and MEI measurements, variability is substantial, leading to significant differences when the criteria for LP are applied, especially for single parameter determinations. Thus, there is a need to establish system specific normal ranges and more accurate criteria for LP parameters.

Precision of an Ambient Sequential Acid Aerosol Sampling System

Abstract The repeatability (i.e., precision) of an automated sequential acid aerosol sampling system was investigated by collocating two identical systems on the roof of an air monitoring site in White Plains, New York (a suburb north of New York City) to collect 6 weeks of daily samples during August and September 1989. The variance of the resulting 41 paired samples was derived for each ion measured. The overall coefficients of variation for SO2- 4 and NH+ 4 were 7.7 percent and 13 percent, respectively, while estimates for H+ ranged from 13 percent to 19 percent. Linear regressions relating data from the paired systems resulted in high coefficients of determination (R2 > 0.93) for all ions. Also, time series plots of the daily ion differences indicated no significant difference between the systems for SO2- 4, NH+ 4, and H+. Paired t-tests of the daily differences affirmed the intersystem agreement for SO2- 4 and NH+ 4; however, this test also indicated a paired difference that was statistically significant but small, when compared to the percent coefficient of variation (%C.V.) for H+. Overall, these results demonstrate and quantify the reliability of this sampling system for characterizing the strong acid content of fine particulate matter. Jaques, P.A.; Thurston, G.D.; Kinney, P.L.; Gorczynski, J.E.: Precision of an Ambient Sequential Acid Aerosol Sampling System. Appl. Occup. Environ. Hyg. 8(4):313-316; 1993.

Reliability of the draft diagnostic criteria for research of ICD‐10 in comparison with ICD‐10 and DSM‐III‐R

The reliability and ease of use of DSM-III-R and the clinical and research versions of ICD-10 were assessed by 5 psychiatrists working in pairs. They diagnosed 60 patients. All 3 systems showed similar and high interrater and intersystem agreement for major diagnostic categories but not for subcategories. A number of implications of these results are discussed.