Abstract
Objective: To analyze the interobserver agreement among physicians in an orthopedy and traumatology service with knowledge and training in adult ankle fracture classifications through radiographic evaluation. Methods: A cross-sectional study was carried out in which the records of 20 patients with a diagnosis of ankle fracture in 2016 (uni-, bi- or trimalleolar), aged older than 18 years or with a closed physis, were studied. The radiographs that met the criteria were analyzed and classified according to the Danis Weber (DW), Lauge-Hansen (LH) and Arbeitsgemeinschaft für Osteosynthesefragen/Orthopaedic Trauma Association (AO/OTA) classifications by two first-year residents, two second-year residents, two third-year residents and two preceptors of the service. The conditions were identical for the observers and were performed individually once. The Kappa coefficient (K) was used to assess agreement. Results: The results showed great interobserver agreement in the DW and LH classifications, with K values equal to 0.69 and 0.64, respectively. The AO/OTA classification showed moderate agreement, with K = 0.47. Conclusion: The DW classification was the most reliable among the three classifications. The AO/OTA classification showed the lowest agreement and was the least reliable, and the LH classification was in between the others. Level of Evidence III, Diagnostic Studies; Study of non consecutive patients; without consistently applied reference “gold” standard.
Highlights
Descritores: Fratura do tornozelo/classificação; Fratura de tornozelo/diagnóstico por imagem; Variações dependentes do observador; Trau matismos do tornozelo; Reprodutibilidade dos testes
The conditions were identical for the observers and were performed individually once
The results showed great interobserver agreement in the DW and LH classifications, with K values equal to 0.69 and 0.64, respectively
Summary
Antonio Candido de Paula Neto, Douglas Hideki Ikeuti, Augusto Braga dos Santos, Rui dos Santos Barroco, Bruno Rodrigues de Miranda, Rafael Rocha Macedo. RESUMO Objetivo: Analisar a concordância inter-observador entre médicos de um serviço de ortopedia e traumatologia com conhecimento e treinamento nas classificações de fraturas de tornozelo de adultos, através de avaliação radiográfica. As radiografias que preencheram os critérios foram analisadas e classificadas de acordo com as classificações de Danis-Weber, Lauge-Hansen e Arbeitsgemeinschaft für Osteosynthesefragen - Orthopaedic Trauma Association (AO-OTA), por dois residentes do primeiro ano, dois residentes do segundo ano, dois residentes do terceiro ano e dois preceptores do serviço. Resultados: Os resultados obtidos foram: nas classificações de Danis-Weber e Lauge-Hansen obteve-se grande concordância inter-observador, com valores de K iguais a 0.69 e 0.64, respectivamente. A classificação da AO-OTA foi a que teve menor concordância, sendo a menos confiável, e a classificação de Lauge-Hansen ficou em uma posição intermediária. Descritores: Fratura do tornozelo/classificação; Fratura de tornozelo/diagnóstico por imagem; Variações dependentes do observador; Trau matismos do tornozelo; Reprodutibilidade dos testes
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