Mo Andrew Z, Miller Patricia E, Glotzbecker Michael P, Li Ying, Fletcher Nicholas D, Upasani Vidyadhar V, Riccio Anthony I, Hresko Michael T, Krengel Walter F, Spence David, Garg Sumeet, Hedequist Daniel J
Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY.
Department of Orthopaedic Surgery, Boston Children's Hospital, Boston, MA.
J Pediatr Orthop. 2020 May/Jun;40(5):e352-e356. doi: 10.1097/BPO.0000000000001521.
The purpose of this study was to determine whether the new AOSpine thoracolumbar spine injury classification system is reliable and reproducible when applied to the pediatric population.
Nine POSNA (Pediatric Orthopaedic Society of North America) member surgeons were sent educational videos and schematic papers describing the AOSpine thoracolumbar spine injury classification system. The material also contained magnetic resonance imaging and computed tomography imaging of 25 pediatric patients with thoracolumbar spine injuries organized into cases to review and classify. The evaluators classified injuries into 3 primary categories: A, B, and C. Interobserver reliability was assessed for the initial reading by Fleiss kappa coefficient (kF) along with 95% confidence interval (CI). For A and B type injuries, subclassification was conducted including A0 to A4 and B1 to B2 subtypes. Interobserver reliability across subclasses was assessed using Krippendorff alpha (αk) along with bootstrapped 95% CI. Imaging was reviewed a second time by all evaluators ~1 month later. All imaging was blinded and randomized. Intraobserver reproducibility was assessed for the primary classifications using Fleiss kappa and subclassification reproducibility was assessed by Krippendorff alpha (αk) along with 95% CI. Interpretations for reliability estimates were based on Landis and Koch (1977): 0 to 0.2, slight; 0.2 to 0.4, fair; 0.4 to 0.6, moderate; 0.6 to 0.8, substantial; and >0.8, almost perfect agreement.
Twenty-five cases were read for a total of 225 initial and 225 repeated evaluations. Adjusted interobserver reliability was almost perfect (kF=0.82; CI, 0.77-0.87) across all raters. Subclassification reliability was substantial (αK=0.79; CI, 0.62-0.90). Adjusted intraobserver reproducibility was almost perfect (kF=0.81; CI, 0.71-0.90) for both primary classifications and for subclassifications (αk=0.81; CI, 0.73-0.86).
The reliability for the AOSpine thoracolumbar spine injury slassification System was high amongst POSNA surgeons when applied to pediatric patients. Given a lack of a uniform classification in the pediatric population, the AOSpine thoracolumbar spine injury classification system has the potential to be used as the first universal spine fracture classification in children.
Level III.
本研究的目的是确定新的AO脊柱胸腰椎损伤分类系统应用于儿科人群时是否可靠且可重复。
向9名北美小儿骨科学会（POSNA）成员外科医生发送了描述AO脊柱胸腰椎损伤分类系统的教学视频和示意图文件。材料还包含25例小儿胸腰椎损伤患者的磁共振成像和计算机断层扫描成像，这些病例被整理用于评估和分类。评估人员将损伤分为3个主要类别：A、B和C。通过Fleiss卡方系数（kF）及95%置信区间（CI）评估初次阅读时的观察者间信度。对于A类和B类损伤，进行了亚分类，包括A0至A4以及B1至B2亚型。使用Krippendorff阿尔法系数（αk）及自抽样95%CI评估各亚类间的观察者间信度。约1个月后，所有评估人员再次对影像进行评估。所有影像均经过盲法处理和随机化。使用Fleiss卡方评估主要分类的观察者内可重复性，使用Krippendorff阿尔法系数（αk）及95%CI评估亚分类的可重复性。可靠性估计的解释依据Landis和Koch（1977年）的标准：0至0.2，轻微；0.2至0.4，一般；0.4至0.6，中等；0.6至0.8，高度；>0.8，几乎完全一致。
共对25例病例进行了225次初次评估和225次重复评估。所有评估人员的校正观察者间信度几乎完全一致（kF = 0.82；CI，0.77 - 0.87）。亚分类信度高度一致（αK = 0.79；CI，0.62 - 0.90）。主要分类和亚分类的校正观察者内可重复性几乎完全一致（主要分类kF = 0.81；CI，0.71 - 0.90；亚分类αk = 0.81；CI，0.73 - 0.86）。
AO脊柱胸腰椎损伤分类系统应用于儿科患者时，在POSNA外科医生中具有较高的可靠性。鉴于儿科人群缺乏统一的分类方法，AO脊柱胸腰椎损伤分类系统有可能成为儿童首个通用的脊柱骨折分类方法。
三级。
