Key result
PRAETORIAN score demonstrates only modest inter-rater reproducibility among naive electrophysiologists.
Why the study?
The study aimed to evaluate the real-life inter-rater variability of the PRAETORIAN score using chest radiographs of S-ICD patients reviewed by independent clinical raters.
Cross-Sectional (n=87)
Yes
Effect estimate: Mean Light's kappa 0.804, Fleiss' kappa 0.249, ICC 0.38
The modest inter-rater agreement of the PRAETORIAN score among self-trained physicians suggests that formal training may be necessary before the tool can reliably replace standard defibrillation testing in clinical practice.
Modest PRAETORIAN inter-rater agreement warrants caution without training; leaves open whether standardized protocols improve reliability.
(1) Background: The PRAETORIAN score is a tool developed for postoperative evaluation of the position of subcutaneous implantable cardioverter-defibrillator systems. The aim of our study was to evaluate the real-life inter-rater variability of the PRAETORIAN score, based on chest radiographs of S-ICD patients reviewed by independent clinical raters. (2) Methods: Postoperative chest X-rays of patients that underwent S-ICD implantation were evaluated by five clinical raters who gave values of the PRAETORIAN score. Ratings were then compared in a fully crossed manner to determine the inter-rater variability of the attributed scores. (3) Results: In total, 87 patients were included in the study. In the case of the most important final risk category of the PRAETORIAN score, the mean Light's kappa was 0.804, the Fleiss' kappa was 0.249, and the intraclass correlation was 0.38. The final risk category was identically determined by all five raters in 75.86% of patients, by four raters in 14.94%, and by three raters in 9.20% of patients. (4) Conclusions: The overall inter-rater variability of the PRAETORIAN score in a group of electrophysiologists experienced in S-ICD implantation, yet previously naive to the PRAETORIAN score, and self-trained in its utilization, was only modest in our study. Appropriate use of the score might require training of clinical raters.
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Budrejko et al. (2022) conducted a cross-sectional in Subcutaneous implantable cardioverter-defibrillator (S-ICD) systems (n=87). PRAETORIAN score evaluation was evaluated on Inter-rater variability of the PRAETORIAN score final risk category (Mean Light's kappa 0.804, Fleiss' kappa 0.249, ICC 0.38). The PRAETORIAN score demonstrated modest overall inter-rater variability for the final risk category among naive electrophysiologists, with a Fleiss' kappa of 0.249 and an intraclass correlation of 0.38.
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