Abstract
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 Guthrie Clinic Sayer, Pennsylvania, USA, 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.
Results: 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% (kappa = 0.77). Intra-rater reliability was 93 % (kappa = 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.