Dragsted Casper, Ohrt-Nissen Søren, Hallager Dennis Winge, Tøndevold Niklas, Andersen Thomas, Dahl Benny, Gehrchen Martin
Spine Unit, Department of Orthopaedic Surgery, Rigshospitalet, University of Copenhagen, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Department of Orthopedics and Scoliosis Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA.
Spine Deform. 2020 Apr;8(2):285-293. doi: 10.1007/s43390-019-00006-2. Epub 2020 Feb 6.
Reproducibility study.
Assess the agreement and reliability of the classification of early onset scoliosis (C-EOS). C-EOS is a promising tool for patients with early onset scoliosis (EOS). However, the reliability has only been examined without measuring radiographs and not including the annual progression rate (APR) modifier.
We included a single-center consecutive cohort of patients diagnosed with EOS seen in our outpatient clinic. Patients had no previous spine surgery. Four raters rated 60 cases. Two anterior-posterior full-spine radiographs, taken minimum 6 months apart, and one sagittal radiograph were measured twice by all raters in a blinded test-retest setup. Results were assessed using crude frequency of overall agreement (OA), intra- and inter-rater Fleiss kappa (κ) statistics, and intraclass correlation coefficient (ICC). We calculated the 95% limits of agreement (LOA) for major curve angle (MCA), kyphosis, and APR using a linear mixed-effects model. Inter- and intra-rater LOA were analyzed for each etiology separately.
Mean age was 8.7 ± 3.4 years and the etiology were congenital/structural (n = 20), idiopathic (n = 19), neuromuscular (n = 13), or syndromic (n = 8). For etiology, OA was 75.8% and κ = 0.80. For major curve angle, OA was 84.2%, κ = 0.86, ICC = 0.97, and LOA = 12.8°. For kyphosis, OA was 55.8%, κ = 0.52, ICC = 0.87, and LOA = 20.6°. For APR, OA was 76.7%, κ = 0.61, ICC = 0.77, and LOA = 17.4°/year. Inter- and intra-rater LOA were generally largest for neuromuscular and smallest for idiopathic patients.
We found substantial agreement for etiology, however, with disagreement in certain cases. The reliability of MCA was excellent; however, somewhat lower for kyphosis and APR with less accuracy. The measurement errors of MCA, kyphosis, and APR depended largely on the etiology. Regarding APR, LOA exceeded the 10°/year increments proposed in the C-EOS, suggesting a revision of this optional modifier.
Diagnostic study level 1.
重复性研究。
评估早发性脊柱侧弯（C-EOS）分类的一致性和可靠性。C-EOS是用于早发性脊柱侧弯（EOS）患者的一种有前景的工具。然而，其可靠性仅在未测量X线片且未纳入年度进展率（APR）修正值的情况下进行过检验。
我们纳入了在我们门诊诊断为EOS的单中心连续队列患者。患者既往无脊柱手术史。四名评估者对60例病例进行评分。在双盲重测设置中，所有评估者对两张前后位全脊柱X线片（间隔至少6个月拍摄）和一张矢状位X线片各测量两次。使用总体一致性（OA）的原始频率、评估者内和评估者间的Fleiss κ统计量以及组内相关系数（ICC）来评估结果。我们使用线性混合效应模型计算主弯角度（MCA）、后凸畸形和APR的95%一致性界限（LOA）。分别针对每种病因分析评估者间和评估者内的LOA。
平均年龄为8.7±3.4岁，病因包括先天性/结构性（n = 20）、特发性（n = 19）、神经肌肉性（n = 13）或综合征性（n = 8）。对于病因，OA为75.8%，κ = 0.80。对于主弯角度，OA为84.2%，κ = 0.86，ICC = 0.97，LOA = 12.8°。对于后凸畸形，OA为55.8%，κ = 0.52，ICC = 0.87，LOA = 20.6°。对于APR，OA为76.7%，κ = 0.61，ICC = 0.77，LOA = 17.4°/年。评估者间和评估者内的LOA一般在神经肌肉性患者中最大，在特发性患者中最小。
我们发现病因方面存在实质性一致性，但在某些情况下存在分歧。MCA的可靠性极佳；然而，后凸畸形和APR的可靠性略低，准确性也较低。MCA、后凸畸形和APR的测量误差在很大程度上取决于病因。关于APR，LOA超过了C-EOS中提议的每年10°的增量，提示对这个可选修正值进行修订。
诊断性研究1级。
