Jayakumar Prakash, Teunis Teun, Giménez Beatriz Bravo, Verstreken Frederik, Di Mascio Livio, Jupiter Jesse B
Department of General Surgery, OLVG, Amsterdam, The Netherlands.
Orthopaedic Upper Extremity Service, Hospital Universitario Doce de Octubre-Universidad Complutense, Madrid, Spain.
J Wrist Surg. 2017 Feb;6(1):46-53. doi: 10.1055/s-0036-1587316. Epub 2016 Aug 8.
The primary objective of this study was to test interobserver reliability when classifying fractures by consensus by AO types and groups among a large international group of surgeons. Secondarily, we assessed the difference in inter- and intraobserver agreement of the AO classification in relation to geographical location, level of training, and subspecialty. A randomized set of radiographic and computed tomographic images from a consecutive series of 96 distal radius fractures (DRFs), treated between October 2010 and April 2013, was classified using an electronic web-based portal by an invited group of participants on two occasions. Interobserver reliability was substantial when classifying AO type A fractures but fair and moderate for type B and C fractures, respectively. No difference was observed by location, except for an apparent difference between participants from India and Australia classifying type B fractures. No statistically significant associations were observed comparing interobserver agreement by level of training and no differences were shown comparing subspecialties. Intra-rater reproducibility was "substantial" for fracture types and "fair" for fracture groups with no difference accounting for location, training level, or specialty. Improved definition of reliability and reproducibility of this classification may be achieved using large international groups of raters, empowering decision making on which system to utilize. Level III.
本研究的主要目的是在一大群国际外科医生中，通过AO分型和分组以达成共识的方式对骨折进行分类时，测试观察者间的可靠性。其次，我们评估了AO分类在观察者间和观察者内一致性方面，与地理位置、培训水平和亚专业的差异。从2010年10月至2013年4月间连续收治的96例桡骨远端骨折（DRF）中随机选取一组X线片和计算机断层扫描图像，由一组受邀参与者通过基于网络的电子平台分两次进行分类。对AO A型骨折进行分类时，观察者间可靠性较高，而对B型和C型骨折，观察者间可靠性分别为一般和中等。除了来自印度和澳大利亚的参与者在对B型骨折进行分类时存在明显差异外，未观察到地理位置方面的差异。比较不同培训水平的观察者间一致性时，未观察到统计学上的显著关联，比较亚专业时也未显示出差异。骨折类型的观察者内再现性为“较高”，骨折组的观察者内再现性为“一般”，且在地理位置、培训水平或专业方面均无差异。使用大型国际评估者群体可能会提高该分类的可靠性和再现性的定义，从而有助于就使用哪种系统做出决策。三级。
