目的评估 DAP 肾肿瘤评分系统的可信度和可重复性.方法收集2013年至2015年于我院行肾部分切除术的110例患者的影像学资料,由5名泌尿外科医师(2名主治医师和3名住院医师)采用DAP 系统独立进行评分,其中2名住院医师间隔3个月后再次进行评分,分别应用Kappa和Kendall tau-b分析法评估同一评分者和2名评分者间DAP各参数及总分的一致性, ICC检验分析不同资历医师的一致性.结果同一评分者DAP各参数及总分的Kappa值分别为0．889、0．817、0．787、0．693和0．897、0．834、0．830、0．708.2名评分者之间DAP各参数及总分的 Ken-dall tau-b值分别为0．896、0．832、0．847、0．832.Bland-Altman 图显示,D、A、P参数均有超过90％的位点在95％的置信区间的参考线内.高年资医师间评分的一致性较低年资医师高.结论 DAP肾肿瘤评分系统在同一评分者及不同评分者间的一致性好,具有良好的可信度和可重复性.%Objective To evaluate the intra-observer and inter-observer reliability of diameter-axial-polar nephrometry score. Methods The imaging data of 110 patients who underwent partial nephrectomy in our hospital were collected and independently scored by 5 urologists (2 attendings and 3 residents).The two residents of these observers were each assigned for a second time three months later.We evaluated intra-observer and inter-observer agreement by Kappa test and Kendall tau-b test,respectively.The variability among all observers with different levels of experience was assessed by intraclass correlation coefficients. Results The intra-observer agreement of all compo-nent scores and sum score indicated by Kappa test were 0.889,0.817,0.787,and 0.693 (0.897, 0.834,0.830,and 0.708 for the other resident).The inter-observer agreement of all component scores and sum score indicated by Kendall tau-b test were 0.896,0.832,0.847,and 0.832,respec-tively.On the Bland-Altman graph,more than 90% of the sites for each DAP components were loca-ted in the 9 5% confidence interval within the reference line.The agreement between more clinically experienced surgeons was higher than j uniors. Conclusions The diameter-axial-polar system is a reliability and repeatability tool with adequate agreement among different observers and by the same observers.
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