Reliability of an electronic uterine diagram to standardize intrauterine adhesion scoring

Laura Miquel; Aubert Agostini; Anderson Loundou; Salima Daoud; Elisabetta Mazza; Malcolm G Munro; Patrice Crochet

doi:10.1016/j.jmig.2024.12.016

Reliability of an electronic uterine diagram to standardize intrauterine adhesion scoring

J Minim Invasive Gynecol. 2024 Dec 30:S1553-4650(24)01567-X. doi: 10.1016/j.jmig.2024.12.016. Online ahead of print.

Authors

Laura Miquel¹, Aubert Agostini², Anderson Loundou³, Salima Daoud⁴, Elisabetta Mazza⁵, Malcolm G Munro⁶, Patrice Crochet⁷

Affiliations

¹ Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France.
² Department of Gynecology and Obstetrics, AP-HM, Assistance Publique-Hôpitaux de Marseille, Marseille, France. Electronic address: aubert.AGOSTINI@ap-hm.fr.
³ CEReSS-Health Service Research and Quality of Life Center, Aix-Marseille University, Support Unit for Clinical Research and Health Economics, AP-HM, Marseille, France.
⁴ Monitoring Force Group, Cedex FRANCE.
⁵ Università degli studi di Milano, Italy.
⁶ UCLA, Los Angeles, CA, USA.
⁷ CHU Rouen Department of Gynecology and Obstetrics, CHU Rouen, Rouen, France.

PMID: 39742960
DOI: 10.1016/j.jmig.2024.12.016

Abstract

Study objective: To study the inter-rater reliability of an electronic complementary uterine diagram (eAFS) in comparison to the conventional American Fertility Society intrauterine adhesions (IUA) scoring system (cAFS). As a secondary aim we wanted to assess the intra-rater reliability of these tools.

Design: This was an observational cross over study with a nested test re-test design.

Setting: Self-identified gynecologists who performed diagnostic hysteroscopy as part of their routine practice were asked to score IUA on 7 preselected videos using both cAFS and eAFS tools in two separate rounds. The order of use of tools was determined at random. Gynecologists who agreed to be involved in a 3^rd round were asked to use the tool they were allocated to in the first round to assess intra-rater variability.

Patients: No patients were recruited for the purpose of this study.

Measurements: Inter-rater agreement between evaluators when using eAFS and cAFS for IUA scoring.

Main results: Overall, the inter-rater agreement was fair (0.25 [CI 0.17 - 0.34] for cAFS and moderate (0.53 [CI 0.48 -0.58] for the eAFS tool. The biggest difference between both tools was seen in the "extent of cavity involved" component, which was fair (0.28 [CI 0.21 - 0.35]) vs. substantial (0.71 [CI 0.64 - 0.78]) for cAFS vs. eAFS respectively. Moreover, agreement coefficients were comparable amongst "expert" and "non-expert" evaluators with the use of the eAFS tool. Moreover, intra-rater perfect agreement was higher with the use of eAFS compared to cAFS (38% vs 32.5%).

Conclusion: The current AFS IUA scoring system has fair inter-rater agreement. However, using a complementary electronic uterine diagram increased this agreement from fair to moderate overall and from fair to substantial in the "extent of adhesions" domain of the tool. Use of the electronic diagram also improved inter-rater agreement amongst non-experts making it comparable to that of experts.

Keywords: AFS score; Synechiae; agreement; fertility; hysteroscopy.