Swiontkowski M F, Sands A K, Agel J, Diab M, Schwappach J R, Kreder H J
Harborview Medical Center, Seattle, Washington, USA.
J Orthop Trauma. 1997 Oct;11(7):467-70. doi: 10.1097/00005131-199710000-00002.
To evaluate the interobserver variation for the AO/OTA fracture classification system: region forty-three-pilon fractures.
One senior attending, two fellows (one trauma, one foot and ankle), one junior orthopaedic resident, and one experienced research coordinator independently classified eighty-four sets of radiographs. The evaluator was blinded as to treatment and functional outcome. The radiographs initially used to manage the patients were evaluated; no special radiographs or standardized radiographic techniques were used. The kappa statistic, Williams index, and SAV statistic were calculated.
Using the SAV statistic to quantify rater agreement beyond that expected by chance alone, the average chance-adjusted agreement among the raters was 0.57 for fracture type, 0.43 for group, and 0.41 for subgroup. This is equivalent to moderate agreement (0.41 to 0.60). The kappa statistic was used to determine whether there was difficulty with any specific category of the AO type classification among raters for selecting fracture type (A, B, C). Kappa values were 0.49 for type A, 0.58 for type B, 0.57 for type C, all of which were considered adequate.
These data are similar to others reported for interobserver agreement with the AO/OTA fracture classification and other classification systems. The issue of individual judgement in taking a continuous variable (fracture pattern) and compartmentalizing it into a dichotomous variable (fracture classification system) is highlighted by these data. Determination of fracture types alone (type A, B, or C) would seem to be sufficient for clinical research where fracture severity should be reported as a variable.
评估AO/OTA骨折分类系统中43区pilon骨折的观察者间差异。
一名资深主治医师、两名住院医师（一名创伤科，一名足踝科）、一名骨科低年资住院医师和一名经验丰富的研究协调员独立对84套X光片进行分类。评估者对治疗和功能结果不知情。对最初用于治疗患者的X光片进行评估；未使用特殊X光片或标准化的放射技术。计算kappa统计量、威廉姆斯指数和SAV统计量。
使用SAV统计量来量化评分者之间超出偶然预期的一致性，评分者之间骨折类型的平均机遇校正一致性为0.57，分组为0.43，亚组为0.41。这相当于中等一致性（0.41至0.60）。kappa统计量用于确定评分者在选择骨折类型（A、B、C）时AO分型的任何特定类别是否存在困难。A类kappa值为0.49，B类为0.58，C类为0.57，所有这些都被认为是足够的。
这些数据与其他报道的关于AO/OTA骨折分类和其他分类系统的观察者间一致性的数据相似。这些数据突出了将连续变量（骨折模式）划分为二分变量（骨折分类系统）时的个体判断问题。对于临床研究，仅确定骨折类型（A、B或C）似乎就足够了，在该研究中骨折严重程度应作为一个变量进行报告。
