Division of Orthopaedic Surgery, The Hospital for Sick Children, 1218-555 University Avenue, Toronto, ON M5G 1X8, Canada. E-mail address for N. Hussain:
J Bone Joint Surg Am. 2015 Jan 21;97(2):e8. doi: 10.2106/JBJS.M.01491.
In 2003, The Journal of Bone & Joint Surgery (American Volume) implemented a requirement for submitted clinical research articles to include a level of evidence rating. The aim of this study was to analyze the agreement between authors and JBJS regarding the level of evidence rating of accepted clinical articles.
A random sample of 353 clinical research articles accepted by JBJS from 2010 to 2012 was analyzed; 188 had a level of evidence rating provided by the author. Articles were grouped by study type and subspecialty. An unweighted kappa value was calculated to measure agreement between the authors and the JBJS editor, whose decision was used as the gold standard. In a secondary analysis, the articles in each subspecialty were categorized according to the year of submission to evaluate temporal trends.
Of the 353 articles, 69.4% (245) were classified by JBJS as representing a therapeutic study, 17.6% (sixty-two) were classified as representing Level-I evidence, and 25.2% (eighty-nine) dealt with arthroplasty. Agreement between the author and the JBJS editor was 0.79 (95% confidence interval [CI], 0.71 to 0.89; p < 0.001) for the study type, 0.62 (95% CI, 0.53 to 0.70; p < 0.001) for the level of evidence, and 0.65 (95% CI, 0.58 to 0.73; p < 0.001) for the full level of evidence rating (study type and level of evidence).
Level of evidence ratings suggested by authors from 2010 to 2012 had moderate to substantial agreement with the ratings assigned by the JBJS editor. This suggests that the level of evidence rating system is being properly understood by authors of articles published in JBJS. However, the low frequency of reporting suggests that JBJS needs to strictly enforce requirements for submission of a level of evidence rating at the time of manuscript submission.
2003 年，《骨科与关节外科杂志》（美国卷）开始要求投稿的临床研究文章必须包含证据分级。本研究旨在分析作者与 JBJS 之间对已接受临床文章证据分级的一致性。
分析了 2010 年至 2012 年 JBJS 接受的 353 篇临床研究文章的随机样本，其中 188 篇文章由作者提供了证据分级。文章按研究类型和亚专科分组。采用非加权 Kappa 值来衡量作者与 JBJS 编辑之间的一致性，以编辑的决定作为金标准。在二次分析中，根据提交年份将每个亚专科的文章分类，以评估时间趋势。
353 篇文章中，69.4%（245 篇）被 JBJS 归类为治疗性研究，17.6%（62 篇）归类为 I 级证据，25.2%（89 篇）涉及关节置换。作者与 JBJS 编辑在研究类型上的一致性为 0.79（95%置信区间[CI]，0.71 至 0.89；p < 0.001），在证据水平上的一致性为 0.62（95%CI，0.53 至 0.70；p < 0.001），在完整的证据水平评级上的一致性为 0.65（95%CI，0.58 至 0.73；p < 0.001）（研究类型和证据水平）。
2010 年至 2012 年作者提出的证据分级与 JBJS 编辑分配的分级具有中等至高度一致性。这表明 JBJS 发表的文章的作者正确理解了证据分级系统。然而，报告的频率较低表明 JBJS 需要在提交稿件时严格执行提交证据分级的要求。
