Teo Tammie L, Schaeffer Emily K, Habib Eva, El-Hawary Ron, Larouche Patricia, Shore Benjamin, Aarvold Alexander, Carsen Sasha, Reilly Christopher, Mulpuri Kishore
Department of Orthopaedic Surgery, British Columbia Children's Hospital, Vancouver, BC, Canada.
Division of Orthopaedics, Dalhousie University, Halifax, NS, Canada.
J Child Orthop. 2020 Dec 1;14(6):502-507. doi: 10.1302/1863-2548.14.200093.
This study examined levels of agreement between paediatric orthopaedic surgeons in the need for operative management of extension-type supracondylar humerus fractures.
This was the second phase of a two-part study. De-identified baseline anteroposterior and lateral elbow radiographs from 60 paediatric patients with extension-type supracondylar humerus fractures were compiled. After classifying each fracture according to Gartland classification guidelines, radiographs were randomized, and surgeons indicated whether they would use operative or non-operative management to treat each fracture. Kappa statistics using pairwise comparisons were calculated to determine agreement levels.
In total, 11 international surgeons participated, and 10/11 completed both survey rounds. The overall weighted interobserver agreement was moderate (0.530, 95%CI [0.215,0.854]) while overall weighted intraobserver agreement was substantial (0.740, 95%CI [0.513,0.963]). The largest variability in preferred treatment methods between surgeons was observed for type IIA fractures, with 6/11 preferring non-operative and 5/11 preferring operative management. The largest individual surgeon variability was observed for type IIA fractures, with 8/11 showing variability (defined by not having made the same decision for at least 90% of the cases) in choosing whether to operate.
Our findings suggest moderate interobserver, and substantial intraobserver agreement in treatment decision making. The largest disagreements between surgeons were observed for type IIA and IIB fractures and treatment decisions did not follow expected trends based on surgeons' preferred treatment methods for each fracture type. This suggests differences in treatment approaches between surgeons in the management of type IIA fractures and highlights the role of other variables that underlie differences between surgeons' treatment preferences.
III.
本研究调查了小儿骨科医生在伸直型肱骨髁上骨折手术治疗必要性方面的一致性水平。
这是一项分为两部分研究的第二阶段。收集了60例伸直型肱骨髁上骨折小儿患者的匿名基线肘部正侧位X线片。根据加特兰分类指南对每例骨折进行分类后，将X线片随机分组，医生指出他们会采用手术还是非手术治疗来处理每例骨折。采用两两比较的卡方统计来确定一致性水平。
共有11名国际医生参与，其中10/11完成了两轮调查。总体加权观察者间一致性为中等（0.530，95%可信区间[0.215,0.854]），而总体加权观察者内一致性为高度一致（0.740，95%可信区间[0.513,0.963]）。在IIA型骨折中观察到医生之间首选治疗方法的最大差异，6/11倾向于非手术治疗，5/11倾向于手术治疗。在IIA型骨折中观察到个体医生的最大差异，8/11在选择是否手术时表现出差异（定义为至少90%的病例未做出相同决定）。
我们的研究结果表明在治疗决策中观察者间一致性中等，观察者内一致性高度一致。在IIA型和IIB型骨折中观察到医生之间最大的分歧，并且治疗决策并未遵循基于医生对每种骨折类型首选治疗方法的预期趋势。这表明在IIA型骨折的治疗中医生之间存在治疗方法的差异，并突出了其他变量在医生治疗偏好差异背后的作用。
III级。
