Grin Andrey, Krylov Vladimir, Lvov Ivan, Talypov Aleksandr, Dzukaev Dmitriy, Kordonskiy Anton, Smirnov Vladimir, Karanadze Vasily, Abdukhalikov Boburmirzo, Khushnazarov Ulugbek, Aleynikova Irina, Kazakova Elza, Bogdanova Olesya, Peyker Alexander, Semchenko Vitaliy, Aksenov Andrey, Borzenkov Anton, Gulyy Vladimir, Torchinov Soslan, Bagaev Sergey, Toporskiy Anton, Nikitin Andrey, Arakelyan Sevak, Martikyan Avetik, Oshchepkov Stanislav, Hovrin Dmitriy, Kojev Aslan, Khalatyan Musheg
Sklifosovsky Research Institute of Emergency Care, Moscow, Russia.
Evdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia.
Global Spine J. 2020 Sep;10(6):682-691. doi: 10.1177/2192568219868218. Epub 2019 Aug 5.
Multicenter observational survey study.
To quantify and compare the inter- and intraobserver reliability of Allen-Fergusson (A-F), Harris, Argenson, and AOSpine (AOS) classifications for cervical spine injuries, in a multicentric survey of neurosurgeons with different levels of experience.
We used data of 64 consecutive patients. Totally, 37 surgeons (from 7 centers), were included in the study. The initial assessment was returned by 36 raters. The second assessment performed after 1.5 months included 24 raters.
We received 15 111 answers for 3840 evaluations. Raters reached a fair general agreement of the A-F scale, while the experienced group achieved κ = 0.39. While all groups showed moderate interrater reliability for primary assessment of Harris scale (κ = 0.44), the κ value for experts decreased from 0.58 to 0.49. The Argenson scale demonstrated moderate and substantial agreement among all raters (κ = 0.47 and κ = 0.55, respectively). The AOS scheme primary assessment general kappa value for all types of injuries and across all raters was 0.49, reaching substantial agreement among experts (κ = 0.62) with moderate agreement across beginner and intermediate groups (κ = 0.48 and κ = 0.44, respectively). The second assessment general agreement kappa value reached 0.56.
We found the highest values of interobserver agreement and reproducibility among surgeons with different levels of experience with Argenson and AOSpine classifications. The AOSpine scale additionally incorporated more detailed description of compression injuries and facet-joint fractures. Agreement levels reached for Allen-Fergusson and Harris scales were fair and moderate, respectively, indicating difficulty of their application in clinical practice, especially by junior specialists.
多中心观察性调查研究。
在一项针对不同经验水平神经外科医生的多中心调查中，量化并比较Allen-Fergusson（A-F）、Harris、Argenson和AOSpine（AOS）颈椎损伤分类法在观察者间和观察者内的可靠性。
我们使用了64例连续患者的数据。共有37名外科医生（来自7个中心）纳入研究。36名评估者返回了初始评估结果。1.5个月后进行的第二次评估有24名评估者参与。
对于3840次评估，我们共收到15111份答案。评估者对A-F量表达成了一般程度的一致，而经验丰富组的κ值为0.39。虽然所有组在Harris量表的初次评估中均显示出中等程度的观察者间可靠性（κ = 0.44），但专家组的κ值从0.58降至0.49。Argenson量表在所有评估者中显示出中等和高度一致性（分别为κ = 0.47和κ = 0.55）。AOS方案对所有类型损伤和所有评估者的初次评估总体kappa值为0.49，在专家中达成高度一致（κ = 0.62），在初学者和中级组中达成中等一致（分别为κ = 0.48和κ = 0.44）。第二次评估的总体一致性kappa值达到0.56。
我们发现，对于Argenson和AOSpine分类法，不同经验水平的外科医生之间观察者间一致性和可重复性的值最高。AOSpine量表还额外纳入了对压缩性损伤和小关节骨折的更详细描述。Allen-Fergusson和Harris量表的一致性水平分别为一般和中等，表明它们在临床实践中应用存在困难，尤其是初级专科医生。
