Concordância intra e interobservadores do sistema de classificação AO para fraturas dos ossos longos na população pediátrica

Abstract

ObjectiveThe AO classification for fractures of the long bones in the pediatric population was developed and validated in 2006. However, the complexity of this system has limited its use in clinical practice and few studies in the literature have evaluated its reproducibility and applicability. The present study had the objective of determining the intra and interobserver concordance using the pediatric AO system, among physicians with different levels of experience. MethodsAfter making the sample calculation, 108 consecutive radiographs on long‐bone fractures in patients aged 0‐16 years, coming from the digital files of the quaternary‐level hospital, were selected. The radiographs were classified by five examiners with different levels of experience after prior explanations about the system. A chart containing images from the classification was made available for consultation. The evaluations were made at two different times by each observer. The Fleiss kappa index was used to ascertain the intra and interobserver concordance. ResultsIntraobserver concordance that was at least substantial was obtained for all the items of the classification and it reached excellent levels for all observers in relation to five of the seven items considered. The interobserver evaluation presented excellent levels of concordance in two items, substantial in two items, moderate to substantial in one item and poor to moderate in one item. No influence from the observer's experience was observed with regard to obtaining higher or lower levels of concordance, either in the intraobserver or in the interobserver evaluation. ConclusionsIn this study, the intra and interobserver concordance was considered to be good or excellent for the pediatric AO classification system, for the parameters of bone, segment, paired bone, subsegment, standard and deviation. However, the intra and interobserver concordance was statistically unsatisfactory for the parameter of severity/side of avulsion. The levels of concordance obtained did not depend on the observer's level of experience within pediatric orthopedics.