PB1006 - Accuracy and interrater agreement of death event adjudications by physician trainees: Validation of the ISTH definition of pulmonary embolism-related death in an autopsy cohort

Monday, June 26, 2023

18:30 – 19:30 ET

Room: Exhibition

Presenting Author(s)

Caterina E. Marx, MD

MD
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Bern, Bern, Switzerland

Co-Author(s)

CS

Carla Schenker

MD
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Bern, Bern, Switzerland
Yan Xu, MD

Thrombosis Fellow
University of Ottawa
Ottawa, Ontario, Canada
SS

Steven Salvatore

MD
Department of Pathology and Laboratory Medicine, Weill Cornell Medical College/NewYork-Presbyterian Hospital, New York, USA
New York, New York, United States
SK

Susan R. Kahn

MD, MSc
McGill University, Montreal, QC, Canada
Montreal, Quebec, Canada
DG

David Garcia

Professor
Division of Hematology, Department of Medicine, University of Washington, Seattle, WA, USA
Seattle, Washington, United States
AD

Aurélien Delluc

Professor, MD, PhD
Department of Medicine, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Canada.
Ottawa, Ontario, Canada
NK

Noémie Kraaijpoel

MD
Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
Amsterdam, Noord-Holland, Netherlands
NL

Nicole J. Langlois

RN, MSc
Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
Ottawa, Ontario, Canada
PG

Philippe Girard

MD
Département Thoracique, Institut Mutualiste Montsouris; Paris, FCRIN INNOVTE, France.
Paris, Ile-de-France, France
Gregoire Le Gal, MD PhD

MD, PhD
Ottawa Hospital Research Institute, University of Ottawa, Canada
Ottawa, Ontario, Canada
Tobias Tritschler, MD, MSc

MD, MSc
Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
Bern, Bern, Switzerland

Background: Central adjudication committees are often composed of experts in the corresponding research field. Provided that clear and widely accepted definitions are used to adjudicate particular clinical events, involving physician trainees in the adjudication process would allow investigators to divide the workload and foster trainees’ research experience.

Aims: To evaluate the accuracy of the ISTH definition of pulmonary embolism (PE)-related death for autopsy-confirmed PE- versus non-PE-related death among physician trainees.

Methods: In this retrospective analysis of consecutive autopsies performed at the NewYork-Presbyterian Hospital, we included all patients with PE-related death between 01/2010 and 07/2019 and patients who died in 2018 from a cause other than PE. The cause of death upon autopsy was determined by the responsible pathologist. Two physician trainees, blinded to autopsy results, reviewed premortem clinical summaries, and independently adjudicated the cause of death in each patient using the ISTH definition of PE-related death. We calculated the sensitivity and specificity of the ISTH definition for autopsy-confirmed PE-related death, and its interrater agreement using percentage agreement and Cohen’s kappa.

Results: Overall, 126 death events were adjudicated (median age 68 years; 60 [48%] women), of which 29 (23%) were due to PE, as confirmed by autopsy (Table). Sensitivity and specificity of the ISTH definition for autopsy-confirmed PE-related death was 48% (95% CI, 29-67) and 100% (95% CI, 96-100), respectively (Figure). Interrater agreement for PE-related death was substantial (percentage agreement, 93%; 95% CI, 87-96; Cohen’s Kappa, 0.67; 95% CI, 44-85).

Conclusion(s): Our findings were very similar to those of a previous validation study in which thrombosis experts adjudicated the same death events (reference: PMID 34255928). They further support the use of the ISTH definition of PE-related death in clinical venous thromboembolism studies and revealed high agreement between adjudicators with varied clinical and adjudication experience.