Zehnder Scott W, Lenarz Christopher J, Place Howard M
Department of Orthopaedic Surgery, St. Louis University School of Medicine, MO 63104, USA.
Spine (Phila Pa 1976). 2009 Sep 1;34(19):2039-43. doi: 10.1097/BRS.0b013e3181af053c.
Reliability and validation study.
The objective of this study is to evaluate a new lower cervical spine injury classification system and assess its reliability, teachability, and clinical applications.
The recently proposed Cervical Spine Injury Severity Score (CSISS) morphologically describes lower cervical spine injuries and grades them on a score of 1 to 20 depending on the integrity of the 4 columns that make up the cervical spine. Early data suggests that this classification system is both reliable and reproducible. Reliability data from additional institutions and data exploring teachability of this classification system is not available.
Fifteen subjects (12 residents and 3 attendings trained in the management of spinal trauma) reviewed radiographs and CT scans of 50 patients and scored them according to the CSISS. Six residents scored the patients 1 month before an instructional lecture given by the senior author and then again immediately following the lecture to assess teachability of the new classification system. All subjects then reviewed the films a final time 1 month later to assess both intraobserver and interobserver reliability. The patients' scores were also analyzed in conjunction with their clinical treatment.
Interobserver reliability overall was excellent (0.975) with junior residents performing similarly to those with more extensive training. Intraobserver reliability was also excellent overall (0.983). Teachability scores improved in the ability to score all 4 columns. Furthermore, this classification system was a fair overall predictor of surgical candidates as a score of 7 predicted 19 out of 26 surgical patients (76% sensitivity, 100% specificity).
The CSISS is a useful new adjunct in the treatment and classification of lower cervical spine injuries. The system is reliable, reproducible, and teachable. It is clinically useful for all levels of orthopedic training and experience.
可靠性与验证性研究。
本研究旨在评估一种新的下颈椎损伤分类系统，并评估其可靠性、可教授性及临床应用情况。
最近提出的颈椎损伤严重程度评分（CSISS）从形态学上描述下颈椎损伤，并根据构成颈椎的4个柱体的完整性将损伤分为1至20分。早期数据表明该分类系统既可靠又具有可重复性。目前尚无来自其他机构的可靠性数据以及探索该分类系统可教授性的数据。
15名受试者（12名住院医师和3名接受过脊柱创伤管理培训的主治医师）查看了50例患者的X线片和CT扫描图像，并根据CSISS对其进行评分。6名住院医师在资深作者进行指导性讲座前1个月对患者进行评分，讲座结束后立即再次评分，以评估新分类系统的可教授性。然后所有受试者在1个月后最后一次查看影像资料，以评估观察者内及观察者间的可靠性。还结合患者的临床治疗情况对其评分进行了分析。
观察者间的总体可靠性极佳（0.975），初级住院医师的表现与训练更丰富的医师相似。观察者内的总体可靠性也极佳（0.983）。在对所有4个柱体进行评分的能力方面，可教授性评分有所提高。此外，作为手术候选者的总体预测指标，该分类系统表现尚可，评分为7分时可预测26例手术患者中的19例（敏感性76%，特异性100%）。
CSISS是下颈椎损伤治疗和分类中一种有用的新辅助工具。该系统可靠、可重复且可教授。对于所有骨科培训水平和经验的人员来说，它在临床上都很有用。
