Agreement between general practitioners and central reviewers on spirometry interpretation in primary care

Abstract

We assessed agreement between general practitioners (GPs) and central reviewers within a supported primary-care spirometry program in Piedmont, Italy. GP and central-review labels were recorded separately; reviewer blinding was not documented. Among 658 uploads dated 18 May 2022-18 January 2023, 481 from 25 GPs had paired obstruction labels. Confidence intervals (CIs) used 50,000 GP-cluster bootstrap resamples. The obstruction agreement was 92.9% (95% CI 90.3-96.0), and Cohen's κ was 0.855 (0.797-0.918); discordance comprised 28 GP-positive/reviewer-negative and 6 GP-negative/reviewer-positive records. Relative sensitivity was 96.8% and specificity 90.4%. Agreement was 95.0% for possible restriction (κ 0.818), 97.5% for recorded reversibility (κ 0.737), and 86.2% for severity (weighted κ 0.789). Four Global Initiative for Chronic Obstructive Lung Disease categories were available, but no very severe classifications were recorded. One reviewer account contributed 397/481 assessments. Incomplete pairs, the concentration of reviews, possible repeat examinations, and the limited number of GP clusters constrain interpretation. Technical-quality data and the bronchodilator-tested denominator were unavailable. High agreement describes completed pairs within this supported pathway and does not establish diagnostic accuracy or clinical benefit. Hospital-community applications require prospective evaluation.

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Cite

BibTeX RIS

BibTeX

@article{misiano2026agreement,
  title = {{Agreement between general practitioners and central reviewers on spirometry interpretation in primary care}},
  author = {Giuseppe Misiano and Daniele Angioni and Andrea Pizzini and Daniela Ferrante and Mirko Parasiliti-Caprino and Vittorio Picottino and Marzio Uberti},
  journal = {Italian Journal of Medicine},
  year = {2026},
  month = oct,
  doi = {10.4081/itjm.2026.2657},
  url = {https://doi.org/10.4081/itjm.2026.2657},
  note = {CC BY-NC},
}

RIS

TY  - JOUR
TI  - Agreement between general practitioners and central reviewers on spirometry interpretation in primary care
AU  - Giuseppe Misiano
AU  - Daniele Angioni
AU  - Andrea Pizzini
AU  - Daniela Ferrante
AU  - Mirko Parasiliti-Caprino
AU  - Vittorio Picottino
AU  - Marzio Uberti
PY  - 2026
DA  - 2026/10/24
JO  - Italian Journal of Medicine
DO  - 10.4081/itjm.2026.2657
UR  - https://doi.org/10.4081/itjm.2026.2657
AB  - We assessed agreement between general practitioners (GPs) and central reviewers within a supported primary-care spirometry program in Piedmont, Italy. GP and central-review labels were recorded separately; reviewer blinding was not documented. Among 658 uploads dated 18 May 2022-18 January 2023, 481 from 25 GPs had paired obstruction labels. Confidence intervals (CIs) used 50,000 GP-cluster bootstrap resamples. The obstruction agreement was 92.9% (95% CI 90.3-96.0), and Cohen's κ was 0.855 (0.797-0.918); discordance comprised 28 GP-positive/reviewer-negative and 6 GP-negative/reviewer-positive records. Relative sensitivity was 96.8% and specificity 90.4%. Agreement was 95.0% for possible restriction (κ 0.818), 97.5% for recorded reversibility (κ 0.737), and 86.2% for severity (weighted κ 0.789). Four Global Initiative for Chronic Obstructive Lung Disease categories were available, but no very severe classifications were recorded. One reviewer account contributed 397/481 assessments. Incomplete pairs, the concentration of reviews, possible repeat examinations, and the limited number of GP clusters constrain interpretation. Technical-quality data and the bronchodilator-tested denominator were unavailable. High agreement describes completed pairs within this supported pathway and does not establish diagnostic accuracy or clinical benefit. Hospital-community applications require prospective evaluation.
SN  - 1877-9344
SN  - 1877-9352
ER  -

Abstract

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