Interrater and intrarater agreement on heart murmurs
AuthorAndersen, Stian; Davidsen, Anne Herefoss; Schirmer, Henrik; Melbye, Hasse; Spigt, Marcus; Aviles Solis, Juan Carlos
Design: Intra- and interrater agreement study.
Subjects: Seventeen GPs and eight cardiologists from Norway and the Netherlands, eight medical students from Norway.
Main outcome measures: Proportion of agreement and kappa coefficients for intrarater agreement and agreement with a reference classification.
Results: The proportion of intrarater agreement on the presence of any murmur was 83% on average, with a median kappa of 0.64 (range k ¼ 0.09–0.86) for all raters, and 0.65, 0.69, and 0.61 for GPs, cardiologist, and medical students, respectively.
Results: The proportion of agreement with the reference on any murmur was 81% on average, with a median kappa of 0.67 (range 0.29–0.90) for all raters, and 0.65, 0.69, and 0.51 for GPs, cardiologists, and medical students, respectively. Results: Distinct murmur, more than five years of clinical practice, and cardiology specialty were most strongly associated with the agreement, with ORs of 2.41 (95% CI 1.63–3.58), 2.19 (1.58–3.04), and 2.53 (1.46–4.41), respectively.
Conclusion: We observed fair but variable agreement with a reference on heart murmurs, and physician experience and specialty, as well as murmur intensity, were the factors most strongly associated with agreement.