Inter-rater agreement in the choice of prophylactic treatment for vestibular migraine and role of an assisted algorithm for this choice

• Published in: Acta otorrinolaringológica española (English) 2020-05, Vol.71 (3), p.140-146
• Main Authors: Domínguez-Durán, Emilio, Baños-López, Pablo, Martín-Castillo, Elena, Galera-Ruiz, Hugo
• Format: Article
• Language: eng ; spa
• ISSN: 2173-5735
• DOI: 10.1016/j.otorri.2019.04.002

BACKGROUND AND OBJECTIVEVestibular migraine (VM) is a cause of episodic vestibular syndrome. There are many drugs available for its prophylaxis and currently the choice is mainly made according to the patient's comorbidities. The aim of this article was to measure the agreement of a group of otorhinolaryngologists in the choice of a prophylactic treatment and to evaluate the role of an assisted algorithm in the choice of this prophylaxis. MATERIAL AND METHODThe medical records of 10 patients with VM were offered to 10 otolaryngologists who were asked to select for each patient the drug they considered most appropriate among five possible options. The Fleiss' κ index was calculated among the 10 otolaryngologists alone, recalculating it including the algorithm as the eleventh evaluator, and Cohen's κ index was calculated between each otolaryngologist and the answers of the algorithm. The otolaryngologists were offered the option to change their responses after knowing the responses of the algorithm and then both indexes were calculated again. RESULTSThe Fleiss' κ index was .302. This index was raised to .343 after introducing the algorithm as an evaluator. After offering the responses proposed by the algorithm, Cohen's κ was improved in 9 of the 10 evaluators, and Fleiss' κ rose to .711. CONCLUSIONSThe agreement between otorhinolaryngologists in choosing prophylaxis for MV can be defined as "fair". The responses of the algorithm for the choice of prophylaxis were close to the average opinion of the otolaryngologists, raising the agreement between them to "substantial".