Data were analyzed using SPSS v23, which included calculations of standard Cohen’s unadjusted Kappa values with their respective 95 % confidence intervals (CIs), raw percentages of agreement, prevalence index, bias index, and raw numbers of positive/negative findings for each examiner. The prevalence index is the absolute difference between concordant agreements on positive/negative findings divided by the total number of subjects [17]. The bias index is calculated in a similar manner but is based upon the discordant agreements on positive and negative findings.

Both the prevalence and bias index values may affect calculation of the Kappa statistic, especially when the prevalence or bias index values are greater than 0.5. Since several tests were associated with high prevalence index values (> 0.5), we also calculated Prevalence And Bias Adjusted Kappa (PABAK) values with their respective 95 % CIs [7]. These PABAK values help to reduce the potential confounding of the high prevalence of positive/negative results of certain testing procedures.

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