This document discusses kappa statistics, which measure interrater reliability beyond chance agreement. Kappa statistics are useful when multiple raters are interpreting subjective data, such as radiology images. The kappa statistic formula calculates observed agreement between raters compared to expected chance agreement. Examples show how to calculate kappa when two raters are assessing whether a biomarker is present or absent in samples. Confidence intervals for kappa are determined using 1.96 as a constant to generate a 95% confidence level.
These annotated slides will help you interpret an OR or RR in clinical terms. Please download these slides and view them in PowerPoint so you can view the annotations describing each slide.
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Study design, Epidemiological study designA study design is a specific plan or protocol
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The laboratory shall determine measurement uncertainty for each measurement procedure,
in the examination phases used to report measured quantity values on patients’ samples. The
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These annotated slides will help you interpret an OR or RR in clinical terms. Please download these slides and view them in PowerPoint so you can view the annotations describing each slide.
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Study design, Epidemiological study designA study design is a specific plan or protocol
for conducting the study, which allows the investigator to translate the conceptual hypothesis into an operational one.
The laboratory shall determine measurement uncertainty for each measurement procedure,
in the examination phases used to report measured quantity values on patients’ samples. The
laboratory shall define the performance requirements for the measurement uncertainty of each
measurement procedure and regularly review estimates of measurement uncertainty.
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Defecation
Normal defecation begins with movement in the left colon, moving stool toward the anus. When stool reaches the rectum, the distention causes relaxation of the internal sphincter and an awareness of the need to defecate. At the time of defecation, the external sphincter relaxes, and abdominal muscles contract, increasing intrarectal pressure and forcing the stool out
The Valsalva maneuver exerts pressure to expel faeces through a voluntary contraction of the abdominal muscles while maintaining forced expiration against a closed airway. Patients with cardiovascular disease, glaucoma, increased intracranial pressure, or a new surgical wound are at greater risk for cardiac dysrhythmias and elevated blood pressure with the Valsalva maneuver and need to avoid straining to pass the stool.
Normal defecation is painless, resulting in passage of soft, formed stool
CONSTIPATION
Constipation is a symptom, not a disease. Improper diet, reduced fluid intake, lack of exercise, and certain medications can cause constipation. For example, patients receiving opiates for pain after surgery often require a stool softener or laxative to prevent constipation. The signs of constipation include infrequent bowel movements (less than every 3 days), difficulty passing stools, excessive straining, inability to defecate at will, and hard feaces
IMPACTION
Fecal impaction results from unrelieved constipation. It is a collection of hardened feces wedged in the rectum that a person cannot expel. In cases of severe impaction the mass extends up into the sigmoid colon.
DIARRHEA
Diarrhea is an increase in the number of stools and the passage of liquid, unformed feces. It is associated with disorders affecting digestion, absorption, and secretion in the GI tract. Intestinal contents pass through the small and large intestine too quickly to allow for the usual absorption of fluid and nutrients. Irritation within the colon results in increased mucus secretion. As a result, feces become watery, and the patient is unable to control the urge to defecate. Normally an anal bag is safe and effective in long-term treatment of patients with fecal incontinence at home, in hospice, or in the hospital. Fecal incontinence is expensive and a potentially dangerous condition in terms of contamination and risk of skin ulceration
HEMORRHOIDS
Hemorrhoids are dilated, engorged veins in the lining of the rectum. They are either external or internal.
FLATULENCE
As gas accumulates in the lumen of the intestines, the bowel wall stretches and distends (flatulence). It is a common cause of abdominal fullness, pain, and cramping. Normally intestinal gas escapes through the mouth (belching) or the anus (passing of flatus)
FECAL INCONTINENCE
Fecal incontinence is the inability to control passage of feces and gas from the anus. Incontinence harms a patient’s body image
PREPARATION AND GIVING OF LAXATIVESACCORDING TO POTTER AND PERRY,
An enema is the instillation of a solution into the rectum and sig
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2. Kappa statistics
◦ The kappa statistic is frequently used to test interrater reliability.(Measurement of the extent to
which data collectors (raters) assign the same score to the same.)
◦ Why we need Kappa???
◦ Some studies involve the need for some degree of subjective interpretation by observers and
often measurement differs with different ‘raters.
◦ intraobserver variation
◦ intrasubject variation
◦ For example:
◦ Interpreting x-ray results = Two radiologists reading same chest x-ray for signs of pneumoconiosis
◦ Two laboratory scientists counting radioactively marked cells from liver tissue
◦ Often same rater differs when measuring the same thing on a different occasion
3. Kappa- agreement
◦ Without good agreement results are difficult to interpret
◦ Measurements are unreliable or inconsistent
◦ Need measures of agreement - kappa
◦ Remember-
Extent to which the observed agreement exceeds that which would be expected by
chance alone (i.e., percent agreement observed − percent agreement expected by
chance alone) [numerator] relative to the maximum that the observers could hope to
improve their agreement (i.e., 100% − percent agreement expected by chance alone)
[denominator].
8. Two raters with binary measure
15 5
4 35
No
Biomarker
present
No
Biomarker
present
Rater 1
Rater
2
Examples:-2 ( slightly different method)
9. Cohen’s Kappa Statistic (κ)
Measures agreement between raters more than expected by chance
+
+
+
+
−
−
=
i
i
i
i
ii
1
represents the marginal probabilities and i = 1,2 the score
10. Two raters with binary measure
15 5 20
4 35 39
19 40 59
No Biomarker
present
No
Biomarker
present
Rater 1
Rater
2
Marginal Total
Marginal
Total
12. Two raters with binary measure
15 5 20
4 35 39
19 40 59
ii = 0.847
i++i = 0.557
+
+
+
+
−
−
=
i
i
i
i
ii
1
557
.
0
1
557
.
0
847
.
0
−
−
=
654
.
0
=
13.
14. Confidence intervals for kappa
◦ Given that the most frequent value desired is 95%, the formula uses
1.96 as the constant.
◦ The formula for a confidence interval = κ – 1.96 x SEκ to κ + 1.96 x Seκ
◦ To obtain the standard error of kappa (SEκ) the following formula
should be used:
