Abstract
ABSTRACT Objective: To evaluate the interobserver agreement of the new AOSpine classification for subaxial cervical fractures. Methods: A descriptive study, which11 traumatic lesions of the subaxial cervical spine (through radiographic and tomographic images), were evaluated by 16 observers being: 6 senior surgeons, 4 fellows in spinal surgery and 6 physicians residents in Orthopedics and Traumatology by the new AOSpine classification, with subsequent statistical analysis of the results. An agreement analysis was performed using the Kappa coefficient, both individually and in combination, with an interpretation of the index performed using the standardized model for Landis and Koch. To determine the level of significance of the analyzes, values less than 0.05 were considered statistically significant. Results: In general, the level of agreement among the examiners was considered reasonable. The lesions “A0 (F3)”, “A4 (F3)”, “B1”, “B3”, “B3 (F3)”, “C”, “C (F3)” and “F3”showed a low level of agreement between the examiners. The level of reasonable agreement was obtained between fractures “A0”, “A1”, “A4”, “B2” and “C (F4)”. The only fracture that presented a moderate level of agreement was the “C (F4 BL)” lesion. This result indicates that the referred injury was the fracture of the subaxial column that presented the best level of agreement among the 16 examiners in the present study. Conclusions: The results of the study indicate an intermediate agreement of the new AOSpine classification for subaxial cervical lesion and point to the need to carry out studies that seek to evaluate this new classification in order to better evaluate its strengths and weaknesses, contributing for its improvement. Level of evidence III; Diagnostic study - investigation of a diagnostic test.
Highlights
Classifications are important in Orthopedics and Traumatology and are frequently used to guide treatment, prognosis, and communication among care teams,[1] in addition to serving to standardize the international scientific language.[2]
The cases presented were classified in different ways by the study examiners. (Table 1) Only one examiner failed to select the type of fracture in one of the study samples
Regarding the type of fracture, injuries A4(F1), B1(F3), B2(F3), C(F1,F4), C(F2), C(F2 BL), C(F2,F4), C(F3,F4), F1, F2, and F4 showed a significance level considered insignificant, with greater probability that these fractures had been classified at random
Summary
Classifications are important in Orthopedics and Traumatology and are frequently used to guide treatment, prognosis, and communication among care teams,[1] in addition to serving to standardize the international scientific language.[2]. A classification must go through three research phases before validation for clinical use. The first phase consists of the development of the classification by a group of physicians experienced in the treatment of the particular injuries, based on several pilot studies. At this stage, concordance among the surgeons must be greater than 90%. The classification is tested by examiners with different levels of knowledge and practice. In the final phase it is applied clinically and documented for some period of time to confirm its validity.[4]
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