From the Trauma Research Unit, Department of Surgery (S.F.M.V.W., E.M.M.V.L., M.M.E.W.), Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Surgery (C.C., F.M.P.), Ernest E Moore Shock Trauma Center at Denver Health, Denver; Colorado School of Public Health (A.S.), University of Colorado Denver, Aurora, Colorado; Chest Wall Injury Society (S.A.S.W.), Salt Lake City, Utah; and Department of Cardiothoracic Surgery (J.G.E.), Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, United Kingdom.
J Trauma Acute Care Surg. 2022 Dec 1;93(6):736-742. doi: 10.1097/TA.0000000000003766. Epub 2022 Aug 31.
In 2020, a universal nomenclature for rib fractures was proposed by the international Chest Wall Injury Society taxonomy collaboration. The purpose of this study is to validate this taxonomy. We hypothesized that there would be at least moderate agreement, regardless of the observers' background.
An international group of independent observers evaluated axial, coronal, and sagittal computed tomography images on an online platform from 11 rib fractures for location (anterior, lateral, or posterior), type (simple, wedge, or complex), and displacement (undisplaced, offset, or displaced) of rib fractures. The multirater κ and Gwet's first agreement coefficient (AC1) were calculated to estimate agreement among the observers.
A total of 90 observers participated, with 76 complete responses (84%). Strong agreement was found for the classification of fracture location ( κ = 0.83 [95% confidence interval (CI) 0.69-0.97]; AC1, 0.84 [95% CI, 0.81-0.88]), moderate for fracture type ( κ = 0.46 [95% CI, 0.32-0.59]; AC1, 0.50 [95% CI, 0.45-0.55]), and fair for rib fracture displacement ( κ = 0.38 [95% CI, 0.21-0.54], AC1, 0.38 [95% CI, 0.34-0.42]).
Agreement on rib fracture location was strong and moderate for fracture type. Agreement on displacement was lower than expected. Evaluating strategies such as comprehensive education, additional imaging techniques, or further specification of the definitions will be needed to increase agreement on the classification of rib fracture type and displacement as defined by the Chest Wall Injury Society taxonomy.
Diagnostic Test or Criteria; Level IV.
2020 年，国际胸壁损伤学会分类协作提出了通用肋骨骨折命名法。本研究旨在验证该分类法。我们假设，无论观察者的背景如何，至少会有中度一致。
一组国际独立观察者在在线平台上评估了 11 处肋骨骨折的轴向、冠状和矢状 CT 图像，以评估肋骨骨折的位置（前、侧或后）、类型（单纯、楔形或复杂）和移位（无移位、偏移或移位）。使用多评价者 κ 和 Gwet 第一一致性系数（AC1）来评估观察者之间的一致性。
共有 90 名观察者参与，其中 76 名完成了 76 次完整回复（84%）。观察者对骨折位置的分类具有很强的一致性（κ=0.83[95%可信区间（CI）0.69-0.97]；AC1=0.84[95%CI，0.81-0.88]），对骨折类型的一致性为中度（κ=0.46[95%CI，0.32-0.59]；AC1=0.50[95%CI，0.45-0.55]），对肋骨骨折移位的一致性为一般（κ=0.38[95%CI，0.21-0.54]；AC1=0.38[95%CI，0.34-0.42]）。
肋骨骨折位置的一致性很强，骨折类型的一致性为中度。对移位的一致性低于预期。需要评估综合教育、额外成像技术或进一步定义等策略，以提高对胸壁损伤学会分类法定义的肋骨骨折类型和移位的分类一致性。
诊断试验或标准；IV 级。
