Neurosurgery Department, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA.
Neurosurgery Department, University of Wisconsin Hospital and Clinics, Madison, Wisconsin, USA.
World Neurosurg. 2019 Jul;127:e101-e107. doi: 10.1016/j.wneu.2019.02.141. Epub 2019 Mar 6.
Spine surgeons at a Level 1 Trauma Center have observed a high incidence of spine and spinal cord injuries owing to falls from tree stands. These injuries have been retrospectively reviewed in the context of the Thoracolumbar Injury Classification and Severity (TLICS) and the Subaxial Cervical Injury Classification and Severity (SLICS) classification systems to assess inter-user reliability and validity. We hypothesize that the inter-rater reliability will be similar between neuroradiology and neurosurgery raters and validity of the scoring system will be maintained at our institution.
The University of Wisconsin Hospital and Clinics' trauma database was reviewed for tree stand-related injuries from 1999 to 2013, with a focus on patients suffering from spine and spinal cord injuries. The TLICS and SLICS scores were then independently determined for these injuries by a neurosurgeon and a neuroradiologist.
When cases were grouped by management recommendation (operative, equivocal, and nonoperative) reviewer agreement was 12/15 (80%) of SLICS and 38/52 (73%) of TLICS scores. Operative SLICS positive predictive value reached 100%, however, with a wide confidence interval. Conversely, the SLICS negative predictive value was poor at 54%-60%, with frequent operative treatment for patients assigned nonoperative scores. TLICS scores reached 77.8% and 93.3% positive predictive value per reviewer, whereas negative predictive values reached 93.9% and 89.2%, respectively.
The TLICS and SLICS systems provide good-to-excellent inter-rater reliability. SLICS validity was poor, whereas TLICS was reasonable for nonoperative cases and moderate for operative cases. Systems such as the TLICS and the SLICS may be best applied in the educational setting to confirm the fracture morphology and presence or absence of ligamentous injury between surgeons and radiologists.
由于从树架上坠落，一级创伤中心的脊柱外科医生观察到脊柱和脊髓损伤的发生率很高。这些损伤已在胸腰椎损伤分类和严重程度（TLICS）和下颈椎损伤分类和严重程度（SLICS）分类系统中进行了回顾性审查，以评估用户间的可靠性和有效性。我们假设神经放射学家和神经外科医生之间的评分者间可靠性相似，并且评分系统的有效性在我们的机构中得以维持。
回顾了威斯康星大学医院和诊所的创伤数据库，以查找 1999 年至 2013 年与树架相关的损伤，重点关注患有脊柱和脊髓损伤的患者。然后，由神经外科医生和神经放射学家独立确定这些损伤的 TLICS 和 SLICS 评分。
当根据管理建议（手术，不确定和非手术）对病例进行分组时，SLICS 的评分者间一致性为 12/15（80％），TLICS 的评分者间一致性为 38/52（73％）。手术 SLICS 阳性预测值达到 100％，但置信区间较宽。相反，SLICS 的阴性预测值较差，为 54％-60％，对于分配给非手术评分的患者，经常进行手术治疗。TLICS 评分每位审阅者的阳性预测值分别达到 77.8％和 93.3％，而阴性预测值分别达到 93.9％和 89.2％。
TLICS 和 SLICS 系统具有良好到极好的评分者间可靠性。SLICS 的有效性较差，而 TLICS 对非手术病例合理，对手术病例适中。TLICS 和 SLICS 等系统可能最适合在教育环境中应用，以在外科医生和放射科医生之间确认骨折形态以及是否存在韧带损伤。
