Concordance of integrated cardiopulmonary exercise testing interpretations using a standard protocol in a population with a background of war trauma

Concordancia de lectura de test de ejercicio cardiopulmonar integrado utilizando un protocolo estándar en una población con antecedente de trauma de guerra

Cardiopulmonary exercise testing assesses exercise tolerance and provides a comprehensive evaluation of the respiratory, cardiovascular, and muscular systems. It is useful in the differential diagnosis of specific cardiopulmonary alterations versus psychological disorders or malingering. However, different interpretations can arise.

Objective: to assess the degree of interobserver concordance in the interpretation of cardiopulmonary exercise testing by using K. Wasserman's algorithm in a population of young patients wounded in combat.

Materials and methods: a study of concordance in the interpretation of 33 cardiopulmonary exercise tests by three observers and two computerized programs. In the first place, the analysis was done between the results of each observation with the final diagnosis given by a consensus of the observers. Secondly, an interobserver analysis was done with the different diagnoses that can be reached by way of the kappa coefficient. A p<0,05 value was considered to be statistically significant.

Results: the best correlations between the observers and the final diagnosis were observed under the categories "normal" and "abnormal", kappa strength of agreement from weak to good (0,2725 - 0,6959 with p<0,05). Kappa values diminished with more specific diagnoses. The best interobserver concordance was found when comparing specific diagnoses, with higher kappa coefficients for the diagnosis of pulmonary diseases.

Conclusion: the diagnostic algorithm used for interpreting cardiopulmonary exercise testing has low overall concordance coefficients for this population. As a consequence, this population requires adequate focusing by way of a clinical history with validated diagnostic algorithms that can be complemented with specific computer programs.