Veljkovic Andrea, Penner Murray, Wing Kevin, Abbas Kaniza Zahra, Salat Peter, Lau Johnny, Femino John E, Phisitkul Phinit, Amendola Annunziato, Younger Alastair
1 Department of Orthopaedics, University of British Columbia, St. Paul's Hospital, Partner, Footbridge Centre for Integrated Foot and Ankle Care.
2 Rosalind Franklin University of Medicine, Chicago Medical School, Chicago, IL, USA.
Foot Ankle Int. 2018 Sep;39(9):1056-1061. doi: 10.1177/1071100718778022. Epub 2018 Jun 4.
Adverse events require consistent recording to determine the effect of alternate treatments. This study was undertaken to evaluate the Vancouver Foot and Ankle WNS complication scale to capture complications (W: wound, N: nerve, S: systemic) to assist in outcome recording.
Interrater reliability was tested in 2 settings: (1) between 2 blinded clinicians in a live clinical setting and (2) between 8 orthopedic surgeons using case vignettes based on a retrospective analysis of 500 foot and ankle procedures performed at the Toronto Western Hospital, Department of Orthopaedics. The intrarater reliability of the WNS scale was tested in a single rater using the case vignettes. Inter- and intrarater reliability were assessed using the Fleiss and Cohen weighted kappa ( k), respectively and 95% confidence intervals (CIs). There was adequate power over 0.8.
In the live clinical setting, the Cohen weighted k (95% CI) values for the W (0.935 [0.862, 1.01]), N (0.914 [0.752, 1.08]), and S (1 [1, 1]) parameters, indicating a near perfect level of agreement between raters. In the broader community of professional foot and ankle surgeons, the Fleiss k values (95% CI) had moderate agreement for the W (0.712 [0.688, 0.735]), N (0.775 [0.738, 0.811]), and high agreement for S (0.834 [0.802, 0.866]) parameters based on case vignettes. However, the Fleiss k values continued to indicate moderate to strong agreement between raters for all parameters.
The WNS scale provided a standardized method of measuring foot and ankle surgical complications. There was at least moderate-strong interrater agreement for all parameters measured on case vignettes and excellent concordance in the live setting.
Level III, comparative series.
不良事件需要进行一致的记录，以确定替代治疗的效果。本研究旨在评估温哥华足踝WNS并发症量表，以记录并发症（W：伤口，N：神经，S：全身），辅助结果记录。
在两种情况下测试了评分者间信度：（1）在现场临床环境中两名不知情的临床医生之间；（2）在8名骨科医生之间，基于对多伦多西部医院骨科进行的500例足踝手术的回顾性分析使用病例 vignettes。使用病例 vignettes 在单一评分者中测试了WNS量表的评分者内信度。分别使用Fleiss和Cohen加权kappa（κ）以及95%置信区间（CI）评估评分者间和评分者内信度。有超过0.8的充足检验效能。
在现场临床环境中，W（0.935 [0.862, 1.01]）、N（0.914 [0.752, 1. .08]）和S（1 [1, 1]）参数的Cohen加权κ（95%CI）值表明评分者之间的一致性接近完美水平。在更广泛的专业足踝外科医生群体中，基于病例 vignettes，Fleiss κ值（95%CI）对于W（0.712 [0.688, 0.735]）参数有中度一致性，对于N（0.775 [0.738, 0.811]）参数有高度一致性，对于S（0.834 [0.802, 0.866]）参数有高度一致性。然而，Fleiss κ值继续表明所有参数在评分者之间有中度到高度一致性。
WNS量表提供了一种测量足踝手术并发症的标准化方法。对于病例 vignettes 所测量的所有参数，评分者间至少有中度到高度一致性，在现场环境中有极佳的一致性。
III级，比较系列研究。
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