Clinical evaluation of anterior vaginal wall support defects: interexaminer and intraexaminer reliability

• Published in: American journal of obstetrics and gynecology Vol. 191; no. 1; pp. 100 - 104
• Main Authors: Whiteside, James L, Barber, Matthew D, Paraiso, Marie F, Hugney, Cathy M, Walters, Mark D
• Format: Journal Article
• Language: English
• Published: Philadelphia, PA Mosby, Inc 01-07-2004; Elsevier
• Subjects: Aged; Biological and medical sciences; Clinical examination; Female; Gynecology. Andrology. Obstetrics; Humans; Medical sciences; Middle Aged; Observer Variation; Paravaginal defect; Prospective Studies; Reliability; Reproducibility of Results; Uterine Prolapse - diagnosis; Paravaginal defect; Clinical examination; Reliability; Wall; Gynecology; Paravaginal defect Clinical examination Reliability; Anterior; Vagina; Obstetrics
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2004.01.053

The purpose of this study was to determine the interobserver and intraobserver reliability of the clinical examination of anterior vaginal wall support defects.
Sixty-three patients with at least stage II anterior vaginal wall prolapse were prospectively evaluated with a standardized examination to detect anterior vaginal wall support defects. Interobserver reliability was assessed with a duplicate examination performed by a blinded second examiner. Intraobserver reliability was assessed with a second examination performed at least 3 weeks later by 1 of the original 2 examiners. Examination reliability for the 4 types of defects (central, right lateral, left lateral, and superior) was evaluated with the kappa statistic.
The inter- and intraexaminer reliability of the clinical examination for central, superior, and right and left paravaginal defects was poor; all kappas were less than 0.50. Overall interexaminer agreement was 42% with a kappa of 0.16 (95% CI, 0-0.32). Overall intraexaminer agreement was 46% with a kappa of 0.16 (95% CI, 0-0.45). Reliability was noted to improve with increasing stage of prolapse.
The clinical examination of anterior vaginal wall support defects displays poor interexaminer and intraexaminer agreement.