Division of Neurosurgery, Department of Clinical Neurosciences, University of Calgary, Alberta, Canada T2N 2T9.
Spine J. 2010 Aug;10(8):697-703. doi: 10.1016/j.spinee.2010.05.011.
The Spine Severity Score (SSS) is a 15-point scoring system devised for the purpose of triaging elective surgical spine referrals. From the referral letter and the accompanying radiology report, a total score is calculated based on clinical, pathological, and radiological criteria; a maximum score of 5 can be obtained within each category. A higher total score represents a referral that should be seen more urgently.
To report interrater and intrarater reliability for the SSS and compare the scoring system against the traditional system for triage, that is, the surgeon's clinical experience.
A prospective cross-comparison design was used to evaluate the reliability and convergent validity of the SSS using spine case referrals.
Four spine surgeons (experts) and three administrative assistants (nonexperts) at the University of Calgary scored 25 referrals. A second iteration of scoring was performed with a minimum time interval elapsed of 6 weeks. Raters were instructed to choose the most concerning (the one with the highest associated score) descriptor in each category that was thought relevant to the individual referral. No further instructions were given on how to interpret the referral letter or the radiology report. The surgeons also scored the referrals using their own preexisting four-point scoring systems. The results were analyzed with independent and dependent t tests, Pearson product moment correlation coefficient, and generalizability and decision analysis.
An independent-measures t test (p>.05) revealed no statistical differences between experts and nonexperts (ie, interrater reliability) for both Iterations 1 and 2 on total scores of the SSS and a moderately strong relationship between their ratings across iterations (r=0.79, p<.001). Similarly, a paired-samples t test (p>.05) indicated a nonsignificant mean difference between Total SSS ratings at Time 1 and Time 2 (ie, intrarater reliability) and a high degree of agreement (r=0.96, p<.001) between the two iterations. These results were confirmed with correlational analyses. Pearson product moment correlation coefficients between the gold standard and the mean score were calculated from expert ratings on Total SSS at Time 1 (r=0.71, p<.001) and at Time 2 (r=0.69, p<.001).
The SSS is a reliable scoring system for triage of elective spine referrals, even among nonexperts. We have been able to demonstrate strong interrater and intrarater reliability for the SSS and moderately strong correlation with the traditional triage system.
脊柱严重程度评分（SSS）是一种 15 分制的评分系统，旨在对选择性脊柱转诊进行分诊。根据转诊信和随附的放射学报告，根据临床、病理和放射学标准计算总分；每个类别最多可获得 5 分。总分越高表示需要更紧急处理的转诊。
报告 SSS 的组内和组间可靠性，并将该评分系统与传统的分诊系统（即外科医生的临床经验）进行比较。
采用前瞻性交叉比较设计，使用脊柱病例转诊来评估 SSS 的可靠性和收敛有效性。
4 名脊柱外科医生（专家）和 3 名行政助理（非专家）在卡尔加里大学对 25 例转诊进行评分。在至少间隔 6 周的时间后进行第二轮评分。评分者被指示选择他们认为与每个转诊相关的每个类别中最相关的（与最高相关评分）描述符。未进一步说明如何解释转诊信或放射学报告。外科医生还使用他们自己的现有四分制评分系统对转诊进行评分。使用独立和配对 t 检验、Pearson 积差相关系数、概化和决策分析对结果进行分析。
独立样本 t 检验（p>.05）显示，在第一轮和第二轮迭代中，专家和非专家之间（即组内可靠性）的 SSS 总分没有统计学差异，并且他们的评分在迭代之间存在中度强关系（r=0.79，p<.001）。同样，配对样本 t 检验（p>.05）表明，在第一轮和第二轮迭代中，总 SSS 评分的平均差异无统计学意义（即组内可靠性），并且两者之间的一致性很高（r=0.96，p<.001）。这些结果通过相关分析得到了证实。从专家在第一轮和第二轮迭代中对总 SSS 的评分计算了与金标准的 Pearson 积差相关系数，分别为 0.71（p<.001）和 0.69（p<.001）。
SSS 是一种可靠的选择性脊柱转诊分诊评分系统，即使在非专家中也是如此。我们已经能够证明 SSS 的组内和组间可靠性很强，并且与传统的分诊系统具有中度强相关性。
