Division of Orthopaedics, Department of Surgery, University of Calgary, Alberta, Canada.
Spine (Phila Pa 1976). 2012 Dec 15;37(26):2161-7. doi: 10.1097/BRS.0b013e3182601469.
This study is a series of thoracic and lumbar spine fracture cases to assess the reliability of thoracolumbar injury classification and severity score (TLICS) in simulated clinical scenarios.
To determine the inter- and intraobserver reliability of TLICS compared with the Denis classification system, and to assess differences based on rater characteristics.
Thoracolumbar injury severity score and TLICS have been subjected to reliability testing using less robust statistical analysis. Both systems have demonstrated poor to good reliability, with particularly weak agreement on the status of the posterior ligamentous complex.
Fifty-four spine fracture cases were selected from a chart review. These cases were scored on 2 occasions by 11 experts using both TLICS and the Denis classification systems. Reliability was assessed using a generalizability coefficient. The primary outcome was interobserver reliability. Secondary outcomes were intraobserver reliability, difference between orthopedic and neurosurgeons, as well as trainees and consultants, and correlation with treatment recommendations.
TLICS demonstrated good interobserver agreement of 0.73 to 0.74. The posterior ligamentous complex component was the least reliable. The Denis classification also demonstrated good reliability between observers, but was least reliable for flexion-distraction injuries. In addition, interobserver reliability between the Denis classification and TLICS morphology subcomponent was strong. TLICS also predicted the need for operative treatment as determined by the experts scoring the injuries.
TLICS is a reliable system for assessing fractures of the thoracic and lumbar spine when used by experts. Similar to previous studies, the posterior ligamentous complex subcomponent score was the least reliable component. Reliability assessment using a generalizability coefficient is a robust method for validating fracture classifications.
本研究为一系列胸腰椎骨折病例，旨在评估胸腰椎损伤分类与严重度评分（TLICS）在模拟临床场景中的可靠性。
与 Denis 分类系统相比，确定 TLICS 的组内和组间可靠性，并评估基于评分者特征的差异。
胸腰椎损伤严重度评分和 TLICS 已通过可靠性测试，但使用的统计分析方法不够稳健。这两种系统的可靠性均已得到验证，结果为差至较好，在后纵韧带复合体状态方面的一致性尤其差。
从病历回顾中选择 54 例脊柱骨折病例。由 11 位专家在 2 次评估中分别使用 TLICS 和 Denis 分类系统进行评分。使用概化系数评估可靠性。主要结局为组间可靠性。次要结局为组内可靠性、骨科医生与神经外科医生之间的差异，以及住院医师与顾问之间的差异，以及与治疗建议的相关性。
TLICS 表现出良好的组间一致性（0.73 至 0.74）。后纵韧带复合体成分的可靠性最低。观察者之间 Denis 分类也表现出良好的可靠性，但对屈伸分离损伤的可靠性最低。此外，Denis 分类和 TLICS 形态子成分之间的组间可靠性较强。TLICS 还预测了专家评估损伤时需要手术治疗的情况。
TLICS 是一种用于评估胸腰椎骨折的可靠系统，当由专家使用时。与之前的研究相似，后纵韧带复合体子成分评分是最不可靠的成分。使用概化系数进行可靠性评估是验证骨折分类的稳健方法。
