Abhishek Nemani, Arshad Ali, Arshad Rehan, Ali Aboufaris, Jabar Ali.
An assessment of inter-rater reliability in the treatment of carotid artery stenosis.
Pak Heart J Jan ;50(3):159-63.

Objective: To determine, through a retrospective case review, if different subspecialty physicians will make consistent therapeutic recommendations for Carotid artery stenosis. Methodology: This retrospective cross sectional study included case review of patients with carotid stenosis presented to from July 2004 to March 2005 . Case reviews of patients were presented to seven physician-raters specializing respectively in: Interventional cardiology (2), Vascular surgery (2), Neurology (2), or Interventional Radiology (1). Each physician reviewed cases independently and recommended a therapeutic option. The physicians were blinded to previous care provided. To test intra-rater reliability, two case-reviews were repeated. Result: A total of 22 cases were reviewed . About 154 responses were obtained. Physician-raters recommended medical management 36% of the time, carotid artery stenting 32% of the times and carotid endarterectomy for 24% of the patients. Eight percent (8%) of the time,physicians made other recommendations, such as further diagnostic evaluation. Inter-rater agreement was 77% ( = 0.77). Intra-rater reliability was 93%( =0.93). Conclusion:+-A multi-specialty team providing care for carotid artery stenosis patients can reduce "turf battles" among various specialties,resulting in better care for the patients. High Intra-rater reliability of 93%points towards a scientific evidence based approach adopted across various specialties.

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