Division of Orthopaedic and Trauma Surgery, Department of Surgery, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
Faculty of Medicine, Clinical Research Center, University of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland; Division of Clinical Epidemiology, Department of Health and Community Medicine, University Hospitals of Geneva, 4, rue Gabrielle-Perret-Gentil, 1211 Geneva 14, Switzerland.
Orthop Traumatol Surg Res. 2021 Oct;107(6):102999. doi: 10.1016/j.otsr.2021.102999. Epub 2021 Jun 30.
A fracture classification system should be a reliable and reproducible means of communication between different observers. It should be logical, comprehensible, and shouldn't contain an unmanageable number of categories. The aim of this study was to assess the intra- and interobserver agreement and reliability of the revised 2018 AO/OTA classification for high-energy pelvic ring injuries (PRI), at the level of the types, groups, subgroups and qualifications.
Agreement and reliability of the revised 2018 AO/OTA classification for high-energy PRI are improved when compared to previous versions of the classification.
Plain radiographs and computed tomography images of a consecutive series of 86 adult patients admitted at a level I trauma center with a high-energy PRI between 01.01.2014 and 31.12.2016 were retrospectively analyzed. Three orthopedic surgeons independently classified these PRI using the 2018 AO/OTA and the Young and Burgess classifications. The senior surgeon analyzed all injuries twice, at 6 months interval, to determine intraobserver reliability. Classification agreement was assessed using percent agreement and classification reliability was assessed using kappa coefficients.
For the intraobserver analysis, injury classifications with the 2018 AO/OTA classification were concordant in 88% of cases (type), 74% (group), 66% (subgroup) and 49% (qualification). Respective kappa coefficients were 0.79, 0.68, 0.62 and 0.47. Interobserver agreement declined from 77% (type) to 42% (group), 36% (subgroup) and 24% (qualification). Respective kappa coefficients were 0.72, 0.48, 0.48 and 0.37. Intraobserver (respectively interobserver) percent agreement with the Young and Burgess classification was 76% (50%) and kappa coefficient was 0.69 (0.51).
The 2018 AO/OTA classification is a reliable tool for daily clinical use and for research purpose at the fracture type level but not at the group, subgroup and qualification levels. These results compare favorably with previously published data for older versions of the classification and may represent an improvement of the AO/OTA classification system in terms of reliability.
III; retrospective diagnostic study.
骨折分类系统应成为不同观察者之间可靠且可重复的沟通方式。它应该具有逻辑性、可理解性，并且不应包含难以管理的分类数量。本研究的目的是评估修订后的 2018 年 AO/OTA 高能骨盆环损伤（PRI）分类在类型、组、亚组和分级方面的观察者内和观察者间一致性和可靠性。
与分类的先前版本相比，修订后的 2018 年 AO/OTA 高能 PRI 分类的一致性和可靠性得到提高。
回顾性分析了 2014 年 1 月 1 日至 2016 年 12 月 31 日期间，在一级创伤中心连续收治的 86 例成人高能 PRI 患者的连续系列的平片和 CT 图像。三名骨科医生使用 2018 年 AO/OTA 和 Young 和 Burgess 分类独立对这些 PRI 进行分类。资深外科医生在 6 个月的间隔内两次分析所有损伤，以确定观察者内可靠性。使用百分比一致性评估分类一致性，使用kappa 系数评估分类可靠性。
对于观察者内分析，使用 2018 年 AO/OTA 分类时，88%（类型）、74%（组）、66%（亚组）和 49%（分级）的损伤分类是一致的。相应的kappa 系数分别为 0.79、0.68、0.62 和 0.47。观察者间一致性从 77%（类型）降至 42%（组）、36%（亚组）和 24%（分级）。相应的 kappa 系数分别为 0.72、0.48、0.48 和 0.37。使用 Young 和 Burgess 分类时，观察者内（分别为观察者间）的百分比一致性为 76%（50%），kappa 系数为 0.69（0.51）。
2018 年 AO/OTA 分类是一种可靠的工具，可用于日常临床使用和研究目的，适用于骨折类型水平，但不适用于组、亚组和分级水平。这些结果与先前发表的该分类旧版本的数据相比具有可比性，并且可能代表了在可靠性方面对 AO/OTA 分类系统的改进。
III；回顾性诊断研究。
