Urrutia Julio, Zamora Tomas, Yurac Ratko, Campos Mauricio, Palma Joaquin, Mobarec Sebastian, Prada Carlos
*Department of Orthopaedic Surgery, School of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile; and †Department of Orthopaedic Surgery, Clinica Alemana de Santiago, Chile.
Spine (Phila Pa 1976). 2015 Jan 1;40(1):E54-8. doi: 10.1097/BRS.0000000000000656.
Agreement study.
To perform an independent interobserver and intraobserver agreement evaluation of the new AOSpine Thoracolumbar Spine Injury Classification System.
The new AOSpine Thoracolumbar Spine Injury Classification System was recently published. It showed substantial reliability and reproducibility among the surgeons who developed it; however, an independent evaluation has not been performed.
Anteroposterior and lateral radiographs, and computed tomographic scans of 70 patients with acute traumatic thoracolumbar injuries were selected and classified using the morphological grading of the new AOSpine Thoracolumbar Spine Injury Classification System by 6 evaluators (3 spine surgeons and 3 orthopedic surgery residents). After a 6-week interval, the 70 cases were presented in a random sequence to the same evaluators for repeat evaluation. The Kappa coefficient (κ) was used to determine the interobserver and intraobserver agreement.
The interobserver reliability was substantial when considering the fracture type (A, B, or C), with a κ= 0.62 (0.57-0.66). The interobserver agreement when considering the subtypes was moderate; κ= 0.55 (0.52-0.57). The intraobserver reproducibility was also substantial, with 85.95% full intraobserver reproducibility considering the fracture type, with κ= 0.77 (0.72-0.83), and was also substantial when considering subtypes with 75.71% full agreement and κ= 0.71 (0.67-0.76). No significant differences were observed between spine surgeons and orthopedic residents in the overall interobserver reliability and intraobserver reproducibility, or in the inter- and intraobserver agreement of specific A, B, or C types of injuries.
This classification allows adequate agreement among different observers and by the same observer on separate occasions. Future prospective studies should evaluate whether this classification improves clinical decision making.
一致性研究。
对新的AO脊柱胸腰椎损伤分类系统进行独立的观察者间和观察者内一致性评估。
新的AO脊柱胸腰椎损伤分类系统最近已发表。在参与制定该系统的外科医生中，它显示出了较高的可靠性和可重复性；然而，尚未进行独立评估。
选取70例急性创伤性胸腰椎损伤患者的前后位和侧位X线片以及计算机断层扫描图像，由6名评估者（3名脊柱外科医生和3名骨科住院医师）根据新的AO脊柱胸腰椎损伤分类系统的形态学分级进行分类。间隔6周后，将这70例病例以随机顺序再次呈现给相同的评估者进行重复评估。使用Kappa系数（κ）来确定观察者间和观察者内的一致性。
在考虑骨折类型（A、B或C）时，观察者间可靠性较高，κ = 0.62（0.57 - 0.66）。在考虑亚型时，观察者间一致性为中等；κ = 0.55（0.52 - 0.57）。观察者内可重复性也较高，在考虑骨折类型时，完全观察者内可重复性为85.95%，κ = 0.77（0.72 - 0.83），在考虑亚型时同样较高，完全一致性为75.71%，κ = 0.71（0.67 - 0.76）。在总体观察者间可靠性和观察者内可重复性方面，以及在特定A、B或C型损伤的观察者间和观察者内一致性方面，脊柱外科医生和骨科住院医师之间未观察到显著差异。
该分类系统在不同观察者之间以及同一观察者在不同时间能够达成充分的一致性。未来的前瞻性研究应评估该分类系统是否能改善临床决策。
