Abstract
BackgroundThe aim of this study was to develop a child-specific classification system for long bone fractures and to examine its reliability and validity on the basis of a prospective multicentre study.MethodsUsing the sequentially developed classification system, three samples of between 30 and 185 paediatric limb fractures from a pool of 2308 fractures documented in two multicenter studies were analysed in a blinded fashion by eight orthopaedic surgeons, on a total of 5 occasions. Intra- and interobserver reliability and accuracy were calculated.ResultsThe reliability improved with successive simplification of the classification. The final version resulted in an overall interobserver agreement of κ = 0.71 with no significant difference between experienced and less experienced raters.ConclusionsIn conclusion, the evaluation of the newly proposed classification system resulted in a reliable and routinely applicable system, for which training in its proper use may further improve the reliability. It can be recommended as a useful tool for clinical practice and offers the option for developing treatment recommendations and outcome predictions in the future.
Highlights
The aim of this study was to develop a child-specific classification system for long bone fractures and to examine its reliability and validity on the basis of a prospective multicentre study
The intraobserver reliability describes the agreement between the ratings of one observer performing repeated classifications of a given entity, whereas the interobserver reliability describes the agreement between the ratings of different observers
The overall case pool that was included in the development of the classification system comprised 2308 fractures
Summary
The aim of this study was to develop a child-specific classification system for long bone fractures and to examine its reliability and validity on the basis of a prospective multicentre study. Classification systems are widely used in orthopaedic and trauma surgery They play a key role in the reporting of clinical and epidemiological data, allowing for uniform comparison and documentation of different conditions. They constitute the semantic basis of retrospective and prospective clinical studies by providing a common language for defining and categorising pathology. Most of the classification studies use the Kappa coefficient introduced by Cohen [3] to quantify the agreement between raters It distinguishes true agreement between various observations from agreement due to chance alone, and is expressed as a value between -1 and 1. The most widely adopted are those of Landis and Koch [4]
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