Helen Sinabulya1, Anders Holmberg2, Lena Blomgren3
1Department of Surgery, Capio St. Gorans Hospital, Stockholm, Sweden; 2Scandinavian Venous Centre, Stockholm, Sweden; 3Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden.
OBJECTIVES: The CEAP classification (clinical-etiology-anatomy-pathophysiology) is the golden standard for classification of chronic venous disease (CVD) today and is often used as part of local guidelines when selecting patients for treatment within the national health care system. Many clinicians find both CEAP and local guidelines difficult to apply in clinical reality, and patients often seek a second opinion if they disagree with the examining doctor. The aim of this study was to evaluate the reproducibility of the clinical class of CEAP when used in a clinical situation where the decision for reimbursement of treatment was made.
METHODS: At a high-volume center in Stockholm, an unselected series of 78 patients (106 limbs) with varicose veins or CVD were examined by 3 independent surgeons with regard to CEAP "C." It was also determined whether there was a medical indication for treatment according to the local guidelines, which would allow for treatment to be funded by the Stockholm County. Pairwise comparison with simple kappa was used to investigate the interobserver reproducibility.
RESULTS: The simple kappa for "C" between all observers was 0.55-0.68 (95% CI), where least agreement was noted in class C3. Medical indication had a simple kappa of 0.35-0.57 (95% CI).
CONCLUSIONS: There was a considerable discrepancy between the surgeons assessing the clinical class of CVD and even more so when deciding the medical indication for treatment. This may be due to inherent difficulties in the CEAP, lack of specific training or the simultaneous assessment of reimbursement that may influence the grading of clinical class.
AUTHOR DISCLOSURES: L. Blomgren: Nothing to disclose; A. Holmberg: Nothing to disclose; H. Sinabulya: Nothing to disclose.
Posted April 2013