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Interrater agreement for two systems used to determine the probability of heparin-induced thrombocytopenia.
[heparin-induced thrombocytopenia]
The
interrater
reliability
of
the
4
T
's
method
and
the
HIT
expert
probability
(
HEP
)
score
for
clinical
evaluation
of
suspected
heparin-induced
thrombocytopenia
(
HIT
)
was
investigated
.
Patients
hospitalized
over
a
three
-
year
period
who
were
tested
for
HIT
via
anti-
platelet
factor
4
(
anti-
PF
4
)
antigen
assay
were
identified
using
laboratory
data
;
127
patient
cases
met
the
study
inclusion
criteria
.
Nine
clinical
pharmacists
with
expertise
in
HIT
management
evaluated
the
127
cases
using
two
pretest
scoring
systems
:
the
4
T
's
score
and
the
HEP
score
.
Each
case
was
independently
evaluated
using
both
4
T
's
and
HEP
scores
.
The
primary
endpoint
was
interrater
agreement
of
overall
4
T
's
and
HEP
scores
and
individual
item
scores
.
Raw
agreement
of
values
assigned
by
the
two
raters
for
each
of
the
four
items
comprising
the
4
T
's
score
ranged
from
0
.
54
to
0
.
86
,
with
agreement
of
0
.
63
for
final
patient
categorizations
.
Raw
agreement
of
rater
weightings
of
the
eight
HEP
scoring
items
ranged
from
0
.
34
to
1
.
0
;
for
dichotomization
of
patients
at
the
suggested
screening
cutoff
value
(
>
2
.
0
)
,
agreement
was
0
.
65
.
Kappa
coefficients
were
0
.
15
-
0
.
45
for
4
T
's
item
scores
and
0
.
17
-
0
.
70
for
HEP
score
item
scores
.
With
both
scoring
systems
,
low
rater
agreement
mainly
related
to
determination
of
the
timing
of
thrombocytopenia
and
possible
other
causes
of
the
disorder
.
In
a
retrospective
study
,
inter-rater
agreement
in
scoring
of
HIT
probability
via
the
4
T
's
and
HEP
scoring
systems
was
relatively
low
.
The
HEP
score
did
not
increase
interrater
reliability
or
correlation
with
anti-
PF
4
antibodies
compared
with
the
4
T
's
score
.
Diseases
Validation
Diseases presenting
"low rater agreement"
symptom
heparin-induced thrombocytopenia
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