Lindenhovius Anneluuk, Karanicolas Paul Jack, Bhandari Mohit, Ring David
Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
J Hand Surg Am. 2012 Apr;37(4):755-9. doi: 10.1016/j.jhsa.2011.12.043. Epub 2012 Mar 6.
This study measured observer variation in radiographic rating of elbow arthrosis.
Thirty-seven independent orthopedic surgeons graded the extent of elbow arthrosis in 20 consecutive sets of plain radiographs, according to the Broberg and Morrey rating system (grade 0, normal joint; grade 1, slight joint-space narrowing with minimum osteophyte formation; grade 2, moderate joint-space narrowing with moderate osteophyte formation; and grade 3, severe degenerative change with gross destruction of the joint). The kappa multirater measure (κ) was used to estimate reliability between observers, with 0 indicating no agreement above chance, and 1 indicating perfect agreement.
There was fair agreement in arthrosis ratings between surgeons. Surgeons with more than 10 years of experience had greater agreement than did surgeons with less experience, and surgeons who treated more than 10 elbow fractures per year had better agreement than did those treating fewer fractures. In post hoc analyses, 2 simplified binary rating systems (eg, "none or mild" vs "moderate or severe" arthrosis) resulted in moderate agreement among observers.
The 4 grades of the Broberg and Morrey classification system have only fair interobserver reliability that is influenced by subspecialty and experience. Binary rating systems might be more reliable.
TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.
本研究测量了肘关节骨关节炎影像学评级中的观察者差异。
37名独立的骨科医生根据布罗伯格和莫里评分系统（0级，关节正常；1级，关节间隙轻度变窄伴最小程度的骨赘形成；2级，关节间隙中度变窄伴中度骨赘形成；3级，严重退行性改变伴关节严重破坏），对连续20组普通X线片上的肘关节骨关节炎程度进行分级。kappa多观察者测量法（κ）用于评估观察者之间的可靠性，0表示一致性不高于随机水平，1表示完全一致。
外科医生之间在骨关节炎评级方面一致性一般。经验超过10年的外科医生比经验较少的外科医生一致性更高，每年治疗超过10例肘关节骨折的外科医生比治疗骨折较少的外科医生一致性更好。在事后分析中，2种简化的二元评级系统（例如，“无或轻度”与“中度或重度”骨关节炎）在观察者之间产生了中度一致性。
布罗伯格和莫里分类系统的4个等级在观察者间的可靠性一般，且受亚专业和经验的影响。二元评级系统可能更可靠。
研究类型/证据水平：诊断性研究III级。
