Understanding Interobserver Agreement: The Kappa Statistic

360 May 2005 Family MedicineIn reading medical literature on diagnosis and inter-pretation of diagnostic tests, our attention is generallyfocused on items such as sensitivity, specificity, pre-dictive values, and likelihood ratios. These items ad-dress the validity of the test. But if the people who ac-tually interpret the test cannot agree on the interpreta-tion, the test results will be of little us suppose that you are preparing to give a lec-ture on community-acquired pneumonia. As you pre-pare for the lecture, you read an article titled, Diag-nosing Pneumonia by History and physical Examina-tion, published in the Journal of the American Medi-cal Association in You come across a table inthe article that shows agreement on physical examina-tion findings of the chest. You see that there was 79% agreement on the presence of wheezing with a kappaof and 85% agreement on the presence of tactilefremitus with a Kappa of How do you interpretthese levels of agreement taking into account the kappastatistic?

radiographs but also to items like physical exam find-ings, eg, presence of wheezes on lung examination as noted earlier. Comparing the presence of wheezes on lung examination to the presence of an infiltrate on a chest radiograph assesses the validity of the exam find-ing to diagnose pneumonia. Assessing whether the ex-

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