| Popis: |
Externally validate the AAGL staging system against surgical complexity, and compare diagnostic accuracy with rASRM stage, as was done in original publication.Retrospective, diagnostic accuracy study SETTING: : Multicentre (Sydney, Australia) PATIENTS: : 317 patients (January 2016 - October 2021) were used in the final analysis INTERVENTIONS: : A database of patients with coded surgical data was analysed.Three independent observers assigned an AAGL surgical stage (1 to 4) as the index test, and surgical complexity level (A to D) as the reference standard. Results from the most accurate of the three observers were used in the final analysis.The weighted kappa score for the overall performance of AAGL stage and rASRM to predict AAGL level was 0.48 and 0.48 respectively (no difference). This was lower than the weighted kappa of 0.62 in the original paper. Diagnostic accuracy (sensitivity, specificity, PPV and NPV) for stage 1 to predict level A 98.5%, 64.3%, 66.3%, and 98.3%; stage 2 to predict level B 31.2%, 90.5%, 27.0%, and 92.1 %; stage 3 to predict level C 12.3%, 94.1%, 59.3%, and 60.7%; stage 4 to predict level D 95.65%, 88.10%, 38.60%, and 99.62%. AUROC for A vs B/C/D (cut-point 9) was 0.87, A/B vs C/D (cut-point 16) was 0.78 and A/B/C vs D (cut-point 22) was 0.94.There was weak to moderate agreement between AAGL stage and AAGL surgical complexity level. Across all key indicators, the AAGL system did not perform as well in this external validation, nor did it outperform rASRM as it did in the reference paper. Results suggest the system is not generalizable. |
