Interobserver and intraobserver reliability of the proposed International Continence Society, Society of Gynecologic Surgeons, and American Urogynecologic Society pelvic organ prolapse classification system,☆☆,

Presented at the Twenty-second Annual Meeting of the Society of Gynecologic Surgeons, Albuquerque, New Mexico, March 4-6, 1996.
https://doi.org/10.1016/S0002-9378(96)70091-1Get rights and content

Abstract

OBJECTIVE: Our purpose was to determine the intraobserver and interobserver reliability of site-specific measurements and stages with the proposed International Continence Society, Society of Gynecologic Surgeons, and American Urogynecologic Society 1994 draft prolapse terminology document. STUDY DESIGN: Women who completed informed consent procedures underwent pelvic examinations by two investigators, each blinded to the results of the other's examination. The reproducibility of the nine site-specific measurements and the summary stage and substage were analyzed with Spearman's correlation coefficient (rs) and Kendel τ B Correlation Coefficient (τb), respectively. Similar analyses were performed on supine and upright examinations performed at two different times by one examiner. RESULTS: Experienced examiners averaged 2.05 minutes per examination and new examiners averaged 3.73 minutes. In the study of interobserver reliability, 48 subjects, mean age 61 ± 14 years, parity 3 ± 2, weight 74 ± 31 kg, comprised the study population. Correlations for each of the nine measurements were substantial and highly significant (rs 0.817, 0.895, 0.522, 0.767, 0.746, 0.747, 0.913, 0.514, and 0.488, p = 0.0008 to <0.0001). Staging and substaging were highly reproducible (τb 0.702 and 0.652). In no subject did the stage vary by more than one; in 69% stages were identical. In the study of intraobserver reliability, for 25 subjects correlations for each of the nine measurements were equally strong (rs 0.780, 0.934, 0.765, 0.759, 0.859, 0.826, 0.812, 0.659, 0.431). Measurements from the upright examinations reflected greater prolapse. Staging and substaging were highly reproducible (τb 0.712 and 0.712). In no subject did the stage vary by more than one; in 64% stages were identical. All stage discrepancies represented an increase in the upright position. CONCLUSIONS: There is good reproducibility of measures with the proposed system. The data suggest that the reliability is independent of examiner experience. Patient position is likely important in maximizing the severity of the prolapse. (Am J Obstet Gynecol 1996;175:1467-71.)

Section snippets

MATERIAL AND METHODS

Examiners included two attending faculty members, three urogynecology fellows, and two third-year residents. Subjects were enrolled from the gynecology outpatient clinics and the gynecologic urodynamic laboratory at the Duke University Medical Center and the Medical University of South Carolina. All duplicate examinations for the interobserver reproducibility study were performed by two examiners at different levels (i.e., faculty-fellow, faculty-resident, or fellow-resident pairs). All

RESULTS

The 48 subjects in the interobserver study had a mean age of 61 years (± 14, range 23 to 81 years), parity of 3 (±2, range 0 to 10), and weight of 74 kg (±31, range 36 to 101 kg). Approximately half the subjects had stage II prolapse, and 25% had stage 0 or 1 or stage III or IV prolapse (Table I). The mean time to complete the examination for all examiners was 3.08 minutes. Experienced examiners averaged 2.05 minutes per examination while new examiners averaged 3.73 minutes. Correlations for

COMMENT

After an extensive review of the literature, Brubaker and Norton3 observed in 1993 that "current clinical nomenclature used to describe pelvic support defects in the English medical literature is not standardized. Such a lack of standardization limits the communication and advancement of knowledge regarding these common clinical problems." The system described in this study represents a joint international effort by three respected societies to provide such standardization.

Although several

References (5)

There are more references available in the full text version of this article.

Cited by (283)

  • Vaginal laxity: Semiology, diagnosis and treatments

    2024, Gynecologie Obstetrique Fertilite et Senologie
View all citing articles on Scopus

From the Departments of Obstetrics and Gynecology, Duke University Medical Centera and the Medical University of South Carolina.b

☆☆

Reprint requests: Richard C. Bump, MD, Duke University Medical Center, Box 3609, Durham, NC 27710.

0002-9378/96 $5.00 + 0 6/6/76471

View full text