Wes Ari M, Naran Sanjay, Sun James, Mazzaferro Daniel, Xu Wen, Nguyen Phuong, Whitaker Linton A, Bartlett Scott P, Taylor Jesse A
Philadelphia, Pa.
From the Division of Plastic Surgery, Children's Hospital of Philadelphia.
Plast Reconstr Surg. 2017 Oct;140(4):579e-586e. doi: 10.1097/PRS.0000000000003688.
The Whitaker classification is a simple and widely used system for describing aesthetic outcomes after craniosynostosis surgery. The purpose of this study is to evaluate its interrater reliability for patients who have undergone fronto-orbital surgery.
A retrospective review of patients with craniosynostosis who underwent surgical intervention at a tertiary referral center was conducted. Inclusion criteria were as follows: single-suture craniosynostosis, surgical intervention before age 2 years, and photographs taken before revisions between 5 and 20 years of age. Thirteen craniofacial surgeons independently reviewed the subjects' photographs and assigned Whitaker classifications. Interrater reliability was assessed with the Cohen kappa statistic.
Twenty-nine subjects were included. Average ages at surgery and at the time of postoperative photography were 0.8 year and 12.8 years, respectively. The κ value for all 13 raters was 0.1567 (p < 0.0001), indicating "slight agreement." Pairwise comparisons demonstrated κ values ranging from 0.0384 to 0.5492. The average rating for the set of 29 photographs differed significantly across the 13 raters (p = 0.0020) and ranged from 1.79 ± 0.68 to 2.79 ± 0.77. Finally, we found that average Whitaker classification did not differ significantly between subjects who subsequently underwent cranioplasty and/or fronto-orbital advancement and those who did not (subsequent procedures, 2.45 ± 0.55; no subsequent procedures, 1.88 ± 0.78; p = 0.1087).
The Whitaker classification exhibits low interrater reliability and does not predict future treatment. It may benefit craniofacial surgeons to create new evaluation tools with greater precision, to improve the quality of patient care and craniofacial outcomes research.
惠特克分类法是一种简单且广泛应用的系统，用于描述颅缝早闭手术后的美学效果。本研究的目的是评估其在接受额眶手术患者中的评分者间信度。
对在一家三级转诊中心接受手术干预的颅缝早闭患者进行回顾性研究。纳入标准如下：单缝颅缝早闭、2岁前接受手术干预、5至20岁翻修术前拍摄的照片。13名颅面外科医生独立查看受试者的照片并给出惠特克分类。用科恩kappa统计量评估评分者间信度。
纳入29名受试者。手术时和术后拍照时的平均年龄分别为0.8岁和12.8岁。所有13名评分者的κ值为0.1567（p<0.0001），表明“轻度一致”。两两比较显示κ值范围为0.0384至0.5492。13名评分者对29张照片的平均评分差异显著（p = 0.0020），范围为1.79±0.68至2.79±0.77。最后，我们发现，随后接受颅骨成形术和/或额眶前移的受试者与未接受者之间的平均惠特克分类无显著差异（后续手术，2.45±0.55；无后续手术，1.88±0.78；p = 0.1087）。
惠特克分类法的评分者间信度较低，且无法预测未来治疗情况。颅面外科医生或许应创建更精确的新评估工具，以提高患者护理质量和颅面治疗效果研究水平。
