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多评估者使用改良骨折愈合评分(AFHS)评估常规 X 线片管状骨的一致性:初步研究。

Multi-Rater Agreement Using the Adapted Fracture Healing Scale (AFHS) for the Assessment of Tubular Bones on Conventional Radiographs: Preliminary Study.

机构信息

Department of Radiology, IRCCS Policlinico San Donato, Piazza Edmondo Malan 2, San Donato Milanese, Italy.

Department of Biomedical and Health Sciences, University of Milan, Via Luigi Mangiagalli 37, Milan, Italy.

出版信息

J Forensic Sci. 2020 Nov;65(6):2112-2116. doi: 10.1111/1556-4029.14541. Epub 2020 Aug 18.

Abstract

Better understanding of the timing of fracture healing may help in cases of interpersonal violence but also of personal identification. The intra- and inter-rater agreement for the adapted fracture healing scale (AFHS) assessing the post-traumatic time interval on radiographs were tested. This is a preliminary study, providing essential information on method reliability for upcoming studies using the AFHS. Five raters (two radiologists, a forensic pathologist, an orthopedist, and an anthropologist) were presented with a test in three parts consisting of 85 radiographs (from 30 adults) of fractures of tubular bones in different stages of healing purposefully selected from more than 1500 radiographs. The raters were firstly asked to assess 15 features describing fracture healing as present, absent, or not assessable. Thereafter, the raters were asked to choose from the AFHS a single-stage best representing the observed healing pattern. The intra- and inter-rater agreement were assessed using single-rating, absolute agreement, two-way mixed-effects intra-class correlation (ICC) coefficients. The intra-rater ICC of radiologist 1 ranged from 0.80 to 0.94. The radiologists' inter-rater ICC ranged from 0.68 to 0.74, while it ranged from -0.01 to 0.90 for the other raters. The good to excellent ICC among the radiologists and forensic anthropologist provides good foundation for the use of the AFHS in forensic cases of trauma dating. The poor to good results for the other physicians indicate that using the AFHS requires training in skeletal anatomy and radiology.

摘要

更好地了解骨折愈合的时间可能有助于处理人际暴力案件,也有助于进行个人身份识别。本研究旨在测试改良骨折愈合评分(AFHS)评估 X 线片上创伤后时间间隔的组内和组间评分者间一致性。这是一项初步研究,为即将使用 AFHS 的研究提供了方法可靠性的基本信息。5 名评分者(2 名放射科医生、1 名法医病理学家、1 名骨科医生和 1 名人类学家)参与了一项测试,该测试分为 3 部分,共 85 张 X 线片(来自 30 名成年人),这些 X 线片是从 1500 多张 X 线片中选择的管状骨骨折不同愈合阶段的 X 线片。评分者首先被要求评估 15 个描述骨折愈合的特征,包括存在、不存在或无法评估。然后,评分者从 AFHS 中选择一个最能代表观察到的愈合模式的单一阶段。使用单评分、绝对一致、双向混合效应组内相关系数(ICC)评估组内和组间一致性。放射科医生 1 的组内 ICC 范围为 0.80 至 0.94。放射科医生的组间 ICC 范围为 0.68 至 0.74,而其他评分者的 ICC 范围为-0.01 至 0.90。放射科医生和法医人类学家之间良好到优秀的 ICC 为 AFHS 在创伤定年法医学案例中的使用提供了良好的基础。其他医生的结果从较差到良好表明,使用 AFHS 需要在骨骼解剖学和放射学方面进行培训。

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