Diagnosis of vertebral fractures in children: is a simplified algorithm-based qualitative technique reliable?

E Adiotomre,M Digby,L Summers,A Allison,A C Offiah,S J Walters,P Broadley,I Lang

doi:10.1007/s00247-015-3537-z

Abstract

BackgroundIdentification of osteoporotic vertebral fractures allows treatment opportunity reducing future risk. There is no agreed standardised method for diagnosing paediatric vertebral fractures.ObjectiveTo evaluate the precision of a modified adult algorithm-based qualitative (ABQ) technique, applicable to children with primary or secondary osteoporosis.Materials and methodsThree radiologists independently assessed lateral spine radiographs of 50 children with suspected reduction in bone mineral density using a modified ABQ scoring system and following simplification to include only clinically relevant parameters, a simplified ABQ score. A final consensus of all observers using simplified ABQ was performed as a reference standard for fracture characterisation. Kappa was calculated for interobserver agreement of the components of both scoring systems and intraobserver agreement of simplified ABQ based on a second read of 29 randomly selected images.ResultsInterobserver Kappa for modified ABQ scoring for fracture detection, severity and shape ranged from 0.34 to 0.49 Kappa for abnormal endplate and position assessment was 0.27 to 0.38. Inter- and intraobserver Kappa for simplified ABQ scoring for fracture detection and grade ranged from 0.37 to 0.46 and 0.45 to 0.56, respectively. Inter- and intraobserver Kappa for affected endplate ranged from 0.31 to 0.41 and 0.45 to 0.51, respectively. Subjectively, observers’ felt simplified ABQ was easier and less time-consuming.ConclusionObserver reliability of modified and simplified ABQ was similar, with slight to moderate agreement for fracture detection and grade/severity. Due to subjective preference for simplified ABQ, we suggest its use as a semi-objective measure of diagnosing paediatric vertebral fractures.

Highlights

There is no agreed standardised method for objective diagnosis of vertebral fractures (VF) in children
Our aim was to identify a reliable scoring system to diagnose vertebral fractures in children, which can be applied for use in children either with primary osteoporosis such as osteogenesis imperfecta or with secondary osteoporosis such as those treated with steroids or who have leukaemia
This study was completed as the side arm of a larger project conducted in a tertiary osteogenesis imperfecta centre with the main aim to establish whether dual X-ray absorptiometry can replace spine radiographs in the assessment of paediatric vertebral morphometry thereby reducing cumulative radiation dose in children

Summary

Introduction

There is no agreed standardised method for objective diagnosis of vertebral fractures (VF) in children. There has been extensive investigation into the assessment of osteoporotic vertebral fractures but very little evaluation of techniques in children [1] for whom assessment of vertebral fractures is hindered by lack of consensus in both radiographic and morphometric definitions of fracture [2, 3]. Osteoporotic vertebral fracture identification in children is important so treatment can be commenced to reduce future fracture risk and morbidity. Identification of osteoporotic vertebral fractures allows treatment opportunity reducing future risk. There is no agreed standardised method for diagnosing paediatric vertebral fractures

Methods

Results

Discussion

Conclusion