Spirometric Flow-Volume Curve. Is Visual Analysis Reliable for Detecting Obstruction in Borderline FEV1/FVC Maneuvers?
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Abstract
Introduction: It is proposed that the concavity of the spirometric flow-volume curve could represent early airflow obstruction. The usual way to report it is through visual analysis.
Methods: Through an anonymous virtual survey directed at specialist and trainee pulmonologists, the concordance in the visual evaluation of the flow-volume curve was assessed using Fleiss' kappa statistic. The survey included only images of curves (14 in total) from maneuvers close to their lower normal limit. These curves were characterized as "obstructive" or "non-obstructive". Additionally, respondents were asked to specify their years of experience and the number of spirometric reports they processed weekly to create subgroups.
Results: A total of 124 surveys were analyzed. The global kappa value was 0.293. The intrasubject kappa analysis showed a value of 0.002. According to years of practice, the values were: <5 years: 0.286; 5 to 10 years: 0.423; >10 years: 0.239. Adjusted by the number of weekly spirometric reports, the results were: less than 10: 0.381; 10 to 30: 0.266; more than 30: 0.227. All values were statistically significant, except for the intrasubject analysis. There were no significant differences in age, FVC, FEV1, FEV1/FVC or their respective z-scores in the maneuvers categorized as “obstructive” or “non-obstructive”.
Conclusions: The kappa values found show minimal concordance among professionals regarding the visual evaluation of the flow-volume curve, with no differences when classified by experience. Therefore, the results are not precise.
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