Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Eur Radiol. 2021 Mar;31(3):1517-1525. doi: 10.1007/s00330-020-07247-0. Epub 2020 Sep 8.
To assess the interobserver reliability (IOR) of the Tile classification system, and its potential influence on outcomes, for the interpretation of CT images of pelvic fractures by radiologists and surgeons.
Retrospective data (1/2008-12/2016) from 238 patients with pelvic fractures were analyzed. Mean patient age was 44 years (SD 20); 66% were male. There were 54 Tile A, 82 Tile B, and 102 Tile C type injuries. The 30-day mortality rate was 15% (36/238). Six observers, three radiologists, and three surgeons with different levels of experience (attending/resident/intern) classified each fracture into one of the 26 second-order subcategories of the Tile classification. Weighted kappa coefficients were used to assess the IORs for the three main categories and nine first-order subcategories.
The overall IORs of the Tile system for the main categories and first-order subcategories were moderate (kappa = 0.44) and fair (kappa = 0.31), respectively. IOR was fair to moderate among radiologists, but only fair among surgeons. By level of training, IOR was moderate between attendings and between residents, whereas it was only fair between interns. IOR was moderate to substantial (kappa = 0.56-0.70) between the radiology attending and resident. Association of the Tile fracture type with 30-day mortality was present based on two out of six observer ratings.
The overall IOR of the Tile classification system is only fair to moderate, increases with the level of rater experience and is better among radiologists than surgeons. In the light of these findings, results from studies using this classification system must be interpreted cautiously.
• The overall interobserver reliability of the Tile pelvic fracture classification is only fair to moderate. • Interobserver reliability increases with observer experience and radiologists have higher kappa coefficients than surgeons. • Interobserver reliability has an impact on the association of the Tile classification system with mortality in two out of six cases.
评估 Tile 分类系统的观察者间可靠性（IOR），以及其对放射科医生和外科医生解读骨盆骨折 CT 图像结果的潜在影响。
回顾性分析了 238 例骨盆骨折患者的资料（2008 年 1 月至 2016 年 12 月）。患者平均年龄为 44 岁（标准差 20 岁）；66%为男性。Tile A 型损伤 54 例，Tile B 型 82 例，Tile C 型 102 例。30 天死亡率为 15%（36/238）。6 名观察者（3 名放射科医生和 3 名外科医生，具有不同的经验水平）将每个骨折分为 Tile 分类的 26 个二级亚类中的一个。使用加权 kapp 系数评估 3 个主要类别和 9 个一级亚类的 IOR。
Tile 系统的总体 IOR 为中等（kappa=0.44）和差（kappa=0.31），适用于主要类别和一级亚类。放射科医生的 IOR 为差至中等，而外科医生的 IOR 仅为差。按培训水平，主治医生与主治医生之间，住院医师与住院医师之间的 IOR 为中等，而实习医生之间的 IOR 为差。放射科医生主治医生与住院医师之间的 IOR 为中等至强（kappa=0.56-0.70）。根据 6 名观察者中的 2 名的评分，Tile 骨折类型与 30 天死亡率之间存在关联。
总体而言，Tile 分类系统的观察者间可靠性仅为中等至差，随着评估者经验水平的提高而增加，并且在放射科医生中优于外科医生。鉴于这些发现，使用该分类系统的研究结果必须谨慎解释。
Tile 骨盆骨折分类的整体观察者间可靠性仅为中等至差。
观察者间可靠性随着观察者经验的增加而增加，放射科医生的 kapp 系数高于外科医生。
在六种情况中的两种情况下，观察者间可靠性会影响 Tile 分类系统与死亡率之间的关联。
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