Reproducibility of the Endometriosis Fertility Index: a prospective inter‐/intra‐rater agreement study

Carla Tomassetti, C Tomassetti, C Bafort, Céline Bafort, Christel Meuleman, C Meuleman, M Welkenhuysen, Myriam Welkenhuysen, S Fieuws, Steffen Fieuws, T D'Hooghe, Thomas D'Hooghe, Thomas D’Hooghe
BJOG: An International Journal of Obstetrics & Gynaecology · 2019 · vol. 127(1) , pp. 107–114 · doi:10.1111/1471-0528.15880 · PMID:31319445 · W2962401626
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This prospective study found high inter- and intra-rater agreement for the Endometriosis Fertility Index (EFI) scoring system among laparoscopy experts and a junior surgeon.

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Abstract

OBJECTIVE: To evaluate the reproducibility of the Endometriosis Fertility Index (EFI). DESIGN: Single-cohort prospective observational study. SETTING: University hospital. POPULATION: Women undergoing laparoscopic resection of any rASRM-stage endometriosis. METHODS: Details of pre- and peroperative findings were collected into a coded research file. EFI scoring was performed en-bloc by three different raters (expert-1 [C.T.], expert-2 [C.M.], junior [C.B.]). Required sample size: 71. Definitions used for agreement: clinical (scores within same range: 0-4, 5-6, 7-10) and numerical (difference ≤1 EFI point). MAIN OUTCOME MEASURES: Primary outcome: rate of clinical agreement between two experts. SECONDARY OUTCOMES: expert numerical agreement, clinical and numerical agreement between expert-1 and junior, and within expert-1 (intra-observer), agreement of rASRM score and -stage. RESULTS: A near 'inter-expert' clinical agreement rate (1.000, 95% CI 0.956-1.000; P = 0.0149) was observed. The numerical agreement between two experts was also high (0.988, 95% CI 0.934-1.000); similarly, high agreement rates were observed for both 'junior-expert' comparisons (clinical 0 .963, 95% CI 0.897-0.992; numerical 0.988, 95% CI 0.934-1.000) and 'intra-expert' comparisons (clinical 0.988, 95% CI 0.934-1.000; numerical 1.000, 95% CI 0.956-1.000). Reasons for disagreements were different scoring of the least-function score and disagreements in rASRM scores. The reproducibility of the rASRM score was clearly inferior to that of the EFI for all comparisons. CONCLUSION: The EFI can be reproduced reliably by different raters, further supporting its use in daily clinical practice as the principal clinical tool for postoperative fertility counselling/management of women with endometriosis. TWEETABLE ABSTRACT: A study confirming the high reproducibility of the EFI substantiates its use in daily clinical practice.

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Outcome instruments

rASRM

Condition tags

mesh:D004715endometriosis

MeSH descriptors

Endometriosis Infertility, Female Adolescent Adult Endometriosis Endometriosis Female Humans Infertility, Female Laparoscopy Middle Aged Observer Variation Prospective Studies Severity of Illness Index Young Adult

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