Department of Surgery, Central Finland Central Hospital, Keskussairaalantie, Jyväskylä, Finland.
Department of Orthopaedics and Traumatology, Oulu University Hospital and University of Oulu, Kajaanintie, Oulu, Finland.
J Orthop Trauma. 2018 Mar;32(3):e97-e101. doi: 10.1097/BOT.0000000000001022.
To investigate the ability of individual surgeons [expert opinion (EO)] to predict distal radius fracture (DRF) healing above a threshold malalignment compared with the majority prediction of the group of surgeons ["majority rule," (MR)] and a statistically derived clinical prediction formula [Edinburgh wrist calculator (EWC)].
Comparative diagnostic study from prospectively collected data of consecutive patients.
Two academic level 1 and 1 academic level 2 trauma centers.
PATIENTS/PARTICIPANTS: Eighteen surgeons assessed probability of healing above a threshold malalignment (often referred to as fracture "instability") for 71 fractures based on radiographs taken initially and after closed reduction and cast application. The probability of losing alignment according to the EWC was dichotomized (likely to lose alignment ≥0.5 vs. unlikely <0.5).
Accuracy parameters of prediction of EO, MR, and EWC.
EWC and MR demonstrated higher accuracy (0.77 and 0.75, respectively) and sensitivity (0.95 and 0.79, respectively) compared with EO (accuracy, 0.66 and sensitivity, 0.58) for predicting healing above the threshold malalignment. Reliability was higher for MR (kappa 0.88) than for EWC (kappa 0.63) or EO (kappa coefficient 0.44). The negative predictive value of the EWC for healing above a threshold of malalignment was excellent (0.97).
Surgeon opinion is not reliable or accurate for predicting loss of alignment of a DRF above a threshold malalignment after closed reduction and immobilization. Dichotomized EWC may be a useful tool in predicting loss of alignment (instability) of a DRF.
Diagnostic Level II. See Instructions for Authors for a complete description of levels of evidence.
研究个别外科医生[专家意见（EO）]预测桡骨远端骨折（DRF）愈合超过阈值对线不良的能力，与外科医生群体的多数预测[多数规则（MR）]以及统计学衍生的临床预测公式[爱丁堡腕计算器（EWC）]相比。
来自连续患者前瞻性收集数据的比较诊断研究。
2 个学术 1 级和 1 个学术 2 级创伤中心。
患者/参与者：18 名外科医生根据初始和闭合复位及石膏固定后拍摄的 X 线片，评估 71 例骨折愈合超过阈值对线不良（通常称为骨折“不稳定”）的可能性。根据 EWC 失去对线的概率被分为两类（可能失去对线≥0.5 与不太可能<0.5）。
EO、MR 和 EWC 预测的准确性参数。
EWC 和 MR 与 EO 相比，在预测愈合超过阈值对线不良方面具有更高的准确性（分别为 0.77 和 0.75）和敏感性（分别为 0.95 和 0.79）。预测愈合超过阈值对线不良时，EO 的准确性较低（准确性为 0.66，敏感性为 0.58）。MR 的可靠性高于 EWC（kappa 0.88 与 kappa 0.63）或 EO（kappa 系数 0.44）。EWC 对愈合超过阈值对线不良的阴性预测值非常好（0.97）。
在闭合复位和固定后，外科医生的意见对于预测 DRF 失去超过阈值对线不良的对线不良并不可靠或准确。二分类 EWC 可能是预测 DRF 对线不良（不稳定）的有用工具。
诊断 II 级。有关证据水平的完整描述，请参阅作者说明。
