Reliability and comparison with the Karnofsky performance scorePålidelighed og sammenligning med Karnofsky score
Background: This study was carried out in Guinea-Bissau ’ s capital Bissau among inpatients and outpatients attending for tuberculosis (TB) treatment within the study area of the Bandim Health Project, a Health and Demographic Surveillance Site. Our aim was to assess the variability between 2 physicians in performing the Bandim tuberculosis score (TBscore), a clinical severity score for pulmonary TB (PTB), and to compare it to the Karnofsky performance score (KPS). Method : From December 2008 to July 2009 we assessed the TBscore and the KPS of 100 PTB patients at inclusion in the TB cohort and/or at 1 or more follow-up visits; 61 baseline and 130 follow-up double assessments were obtained. Results : The inter-observer variability of the TBscore (5 symptoms and 6 clinical fi ndings) varied from slight to almost perfect agreement. For the TBscore, all 3 severity classes (SC I – III) were observed, while the KPS only yielded 2 of its 3 possible classes. The grading of PTB patients into severity classes showed moderate agreement for both the TBscore ( κ w 0.52, 95% confi dence interval 0.46 – 0.56) and the KPS ( κ w 0.49, 95% confi dence interval 0.33 – 0.65). The intra-class correlation coeffi cient (ICC) was larger for the TBscore than for the KPS (0.822 vs 0.632). Conclusions : The Bandim TBscore had an acceptable inter-observer variability, seemed to be more disease-related, and performed better than the KPS.
Scandinavian Journal of Infectious Diseases, 2013, Vol 45, Issue 4, p. 256-264