Fleiss Kappa Research Articles

An inter-assessor reliability study on the categorization and staging of pressure injuries

BackgroundThe first step in effective management of pressure injuries (PIs) is to assess, categorize and stage correctly. PurposeThis study aims to examine the agreement regarding the classification and staging of PIs among nurse academicians working on chronic wounds and with different stage of expertise. MethodsThree nurse academicians were assigned as assessors according to Benner's stages of clinical competence (Competent, Proficient, and Expert). The assessors independently evaluated PIs photographs (n = 694). The assessors then met for the wounds where there was disagreement, and a Consensus agreement was reached. Kappa Statistics analysed the agreement between two assessors; Fleiss Kappa Statistics analysed the agreement between Competent, Proficient, Expert, and Consensus. ResultsStatistically, almost perfect agreement was obtained between Competent, Proficient, Expert, and Consensus assessments, respectively (Ƙ = 0.871; p < 0.001, Ƙ = 0.842; p < 0.001, Ƙ = 0.937; p < 0.001). The highest agreement between the assessors were Unstageable PIs, Deep Tissue PIs, and Stage 3 PIs respectively. The most common disagreements were between Deep Tissue PIs and Stage 1 PIs, and between Deep Tissue PIs and Stage 2 PIs. ConclusionIn the study, it was found that the categorization, and staging of PIs had varying degrees of reliability among the assesors, although at a statistically acceptable level.

The Psychological Impact of Anterior Teeth Caries and Treatment Needs Among Adults at King Saud University Clinics in Riyadh, Saudi Arabia.

Introduction Aesthetic dentistry has become increasingly important, as a smile is key to social and emotional well-being. Dental caries can greatly and persistently diminish overall oral health-related quality of life, impacting one's capacity to engage socially and maintain emotional health. The study aims to assess the psychological impact of anterior teeth caries and restorative treatment needs. Methodology A cross-sectional study was conducted at King Saud University clinics. The questionnaire used in this study was developed based on previous research and structured into three main domains: demographic data, psychosocial impact of dental aesthetics, and restorative treatment needs assessment. The statistical analysis of the study's Inter-rater reliability was assessed using the Fleiss kappa coefficient. The intra-rater reliability was evaluated for all raters using Cohen's kappa, with each rater showing almost perfect agreement in dental caries and treatment option measures (p < 0.001). Results The participants who perceived the presence of anterior caries had significantly worse overall psychological impact scores than those who did not perceive having anterior caries. The overall Psychosocial Impact of the Dental Aesthetics Questionnaire (PIDAQ) score shows a more negative psychosocial impact of dental aesthetics on those needing indirect restoration than those needing direct restorations. Conclusions Anterior teeth caries significantly impacts individuals' psychological well-being, particularly in emotional and social aspects. Those perceiving the presence of anterior caries experience more significant emotional distress and social implications. The need for restorative treatment, especially indirect restoration, is associated with higher psychosocial impact and lower dental self-confidence.

A new era of high-resolution CT diagnostics of the lung: improved image quality, detailed morphology, and reduced radiation dose with high-resolution photon-counting CT of the lungs compared to high-resolution energy-integrated CT.

High-resolution computed tomography (HRCT) is dependent on detailed morphology in diagnostic assessment of interstitial lung diseases. Photon-counting CT (PCCT) enables improved resolution while reducing radiation. To compare if the image quality, detailed morphology, and radiation dose in HRCT of the lung improves with PCCT compared to energy-integrated CT (EICT). HRCT with PCCT in patients with body mass index (BMI) from normal to obese, previously examined with different EICT were included. They were evaluated in a five-step scale for image quality according to Quality Criteria for CT (Diagnostic Requirement of the ImPACT group-European standardization). In addition, ground-glass opacities, bronchiectasis, emphysema, nodules, and subpleural detailed morphology (≤1 cm from the pleural border) were evaluated by three independent thoracic and/or pediatric radiologists. Visual grading characteristics (VGC) were used for comparison of image quality and detailed morphology and Fleiss kappa for intra-observer variability. Dose-length product (DLP) and CT dose index-volume (CTDIvol) were collected to calculate effective radiation dose. HRCT with PCCT in 52 women and 48 men (mean age=67.2 ± 13.6 years; age range=27-87 years; BMI=26.9 kg/m2; range=18.6-45 kg/m2) previously examined with EICT (mean age=65.3 ± 13.6 years; age range=27-85 years; BMI=27 kg/m2; range=18.9-45 kg/m2) were included. There were significant differences in image quality for all entities in favor of PCCT. The radiation dose was reduced with PCCT by 47% in all, particularly pronounced in obese with 48.5%. Image quality, detailed morphology, and radiation dose, particularly in obese patients, were significantly improved in HRCT with PCCT compared to conventional EICT. The new technique enables visualization of subpleural structures.

Application of the Modified RUST Score in Tibial Bone Transport and Factors Associated with Docking Site Complications.

Reconstruction of segmental bone defects with bone transport is a well-established treatment. Mechanical complications at the docking site after frame removal are common. These complications include malunion, non-union, axial deviation and refracture. A simple tool to assess the healing of the docking site is currently lacking. The aim of this study is to evaluate the use of the modified RUST (mRUST) score in the setting of bone transport and to identify factors associated with an increased risk of docking site complications. This retrospective study was conducted at a single tertiary centre in South Africa, included 24 patients with a tibial bone defect treated with bone transport and a circular frame between 2014 and 2023. Demographic data, clinical and bone transport characteristics were recorded. Mechanical complications, such as fracture, non-union, any angulation >5°, shortening >5 mm, or any other complication requiring reoperation, were recorded. The mRUST was adapted as a ratio for the purpose of this study to overcome the common occurrence of cortices being obscured by the frame. The mRUST ratio was applied before and after frame removal for each patient by three appraisers. Comparison between the groups with and without complications was performed regarding bone transport characteristics, docking site configuration and mRUST ratio. The correlation of the score between radiographs before and after frame removal was assessed. The inter-rater reliability of the mRUST was analysed using Fleiss Kappa statistics for each cortex individually and the intraclass correlation coefficient (ICC) for the mRUST ratio. In this study, 20 men and 4 women with a median age of 26 years were included. The overall rate of mechanical complications after frame removal was 21.7%. Complications were all related to the docking site, with two angulations, two fractures and one non-union. Demographics, bone transport characteristics and mRUST ratio before and after frame removal were similar between the two groups. Regarding the configuration of the docking site, an angle of 45° or more between the bone surfaces was associated with the occurrence of mechanical complications (p < 0.001). The correlation of the mean mRUST ratio before and after frame removal showed a moderate relationship, with a Spearman correlation coefficient of 0.50 (p-value 0.13). The inter-rater reliability of the mRUST was "fair" (kappa 0.21-0.40) for the scoring of individual cortices, except for one score which was "slight" (kappa 0.00-0.20). The ICC of the mRUST ratio was 0.662 on radiographs with the frame, and 0.759 after frame removal. This study did not find the mRUST or mRUST ratio useful in assessing the healing of the docking site to decide on the best time to remove the frame. However, a notable finding was that the shape and orientation of the bone ends meeting at the docking site might well be relevant to decrease complication rates. If the angle between the bony surfaces is 45° or more, it may be associated with an increased risk of complications. It may be worthwhile considering reshaping these bone ends at the time of debridement or formal docking procedure to be more collinear, in order to reduce the potential for mechanical complications such as non-union, axial deviation or refracture at the docking site. Kummer A, Nieuwoudt L, Marais LC. Application of the Modified RUST Score in Tibial Bone Transport and Factors Associated with Docking Site Complications. Strategies Trauma Limb Reconstr 2024;19(2):73-81.

Accuracy and Completeness of Large Language Models About Antibody-Drug Conjugates and Associated Ocular Adverse Effects.

The purpose of this study was to assess the accuracy and completeness of 3 large language models (LLMs) to generate information about antibody-drug conjugate (ADC)-associated ocular toxicities. There were 22 questions about ADCs, tisotumab vedotin, and mirvetuximab soravtansine that were developed and input into ChatGPT 4.0, Bard, and LLaMa. Answers were rated by 4 ocular toxicity experts using standardized 6-point Likert scales on accuracy and completeness. ANOVA tests were conducted for comparison between the 3 subgroups, followed by pairwise t-tests. Interrater variability was assessed with Fleiss kappa tests. The mean accuracy score was 4.62 (SD 0.89) for ChatGPT, 4.77 (SD 0.90) for Bard, and 4.41 (SD 1.09) for LLaMA. Both ChatGPT (P = 0.03) and Bard (P = 0.003) scored significantly better for accuracy when compared with LLaMA. The mean completeness score was 4.43 (SD 0.91) for ChatGPT, 4.57 (SD 0.93) for Bard, and 4.42 (SD 0.99) for LLaMA. There were no significant differences in completeness scores between groups. Fleiss kappa assessment for interrater variability was good (0.74) for accuracy and fair (0.31) for completeness. All 3 LLMs had relatively high accuracy and completeness ratings, showing LLMs are able to provide sufficient answers for niche topics of ophthalmology. Our results indicate that ChatGPT and Bard may be slightly better at providing more accurate answers than LLaMA. As further research and treatment plans are developed for ADC-associated ocular toxicities, these LLMs should be reassessed to see if they provide complete and accurate answers that remain in line with current medical knowledge.

A New Index for Assessment of Severity and Extent of Gingival Pigmentation; A Diagnostic Cross-Sectional Study According to Inter and Intra-Observer Variability.

Classification of gingival pigmentation (GP) is often performed using gingival pigmentation index (GPI), melanin pigmentation index (MPI), oral pigmentation index (DOPI), melanin index (MI), or physiologic/pathologic GPI. However, the internal and external reproducibility of these indexes have not been evaluated. This study aimed to introduce a new simple and applicable GPI and assess its internal and external reproducibility. This diagnostic cross-sectional study was conducted on 40 patients with maxillary and mandibular GP. Patients were in the age range of 12-60 years, and degree of GP was determined by four periodontists using DOPI, MI, MPI, GPI and the new index namely the severity and extension of gingival melanotic pigmentation index (SEMPI) under similar environmental and lighting conditions. The inclusion criteria were in the age range of 12-60 years and presence of melanin pigmentation (physiologic or pathologic) in the gingival margin, papilla, or attached gingiva. The exclusion criteria were systemic diseases, vascular lesions, hemochromatosis, amalgam tattoo, hyperbilirubinemia, or use of medications causing nonmelanotic pigmentation (hemoglobin, iron, and amalgam). The Fleiss kappa between all examiners for all indexes at 0, 7, and 14 days was higher than 0.8, indicating high agreement among the examiners. The Spearman's correlation coefficient for all indexes was positive and high at 0, 7, and 14 days (P < 0.001). Considering the high agreement among the examiners for all indexes and at all-time points as well as the positive, strong correlations among them, it seems that the new index is useful for classification of GP.

Location of medial collateral ligament tears: introduction to a magnetic resonance imaging-based classification.

Despite established tear grade classifications, there is currently no radiological classification for sMCL tear locations. This study aims to establish a magnetic resonance imaging (MRI) tear location classification system for sMCL tears, to enhance understanding and guide treatment decisions by categorizing tear types. A retrospective search in a single institution's MRI database identified patients with acute, Grade III sMCL tears (< 30days between injury and MRI) from January to December 2022. Non-acute and partial tears were excluded, and three observers assessed tear types based on the proposed sMCL MRI tear location system: type I (proximal 25%), Ib (proximal femoral bony avulsion), II (midsubstance, 25-75%), III (distal 25%), IIIb (distal tibial bony avulsion), IIIs (Stener-like lesion). The interclass correlation coefficient (ICC) was used to assess interrater and intrarater reliability for continuous data; Fleiss and Cohen's kappa assessed interrater and intrarater reliability for categorical data. MRI scans of thirty patients with diagnosed sMCL injuries (53% female, mean age 37 ± 13years, range 16-68years) were included based on inclusion/exclusion criteria. Interrater reliability was excellent (ICC: 0.968, 95% CI, 0.933-0.985), and intrarater reliability was excellent (ICC: 0.938, 95% CI: 0.874-0.970 & 0.900, 95% CI, 0.789-0.952). Type I injuries were most common (60%), followed by type III (33.3%), type II (3.3%), type Ib (3.3%), type IIIb (0.0%), and type IIIs (0.0%). The presented MRI-based sMCL tear location classification provides a reproducible system for grading high-grade sMCL injuries. We propose that this framework will significantly unify tear location understanding and support more informed treatment decisions.

Evaluation of the Information Content of YoutubeTM Videos in Turkish on Botulinum Toxin Injection Administered to the Masseter Muscle in the Treatment of Bruxism: A Cross-Sectional Study: Bruxism and Botox on Youtube

Objective:The study aims the evaluation the content on the YouTubeTM platform about botulinum toxin injection for the treatment of bruxism regarding information quality. Methods: The YoutubeTM database was scanned using the keyword "masseter botox." According to the study criteria, 33 videos were included and the number of views, likes, dislikes, comments, duration, and the number of days since uploading were recorded. According to their quality, the information content was divided into four groups (bad, poor, good, excellent). Shapiro-Wilk, Kruskal-Wallis, and post-hoc Tamhane-T2 tests were used to analyze the study data, and Fleiss Kappa analysis was used to evaluate the agreement between researchers. Statistical significance was determined as p&amp;lt;0.05. Results: According to the installer source, 19 videos were uploaded by doctors, seven by patients, five by doctors+patients, and two by other sources. Significant differences were obtained between the uploaded source and the duration of the video; the number of views, the number of likes, dislikes, comments, interaction index, and viewing rate were respectively p&amp;lt;0.001, p=0.035, p=0.003, p=0.008, p=0.002, p=0.007, and p=0.013. According to the information content, 14 videos were bad, 15 were poor, and four had good information. A significant difference was observed between the number of comments (p=0.016) and video duration (p=0.029) regarding the information content quality. Conclusion: The results have indicated that YouTubeTM content cannot be a reliable source of information. Experts should recommend videos that meet specific standards to patients and produce content that provides accurate information in the absence of this content.

Trauma-related preventable death; data analysis and panel review at a level 1 trauma centre in Amsterdam, the Netherlands.

Trauma-related death is used as a parameter to evaluate the quality of trauma care and identify cases in which mortality could have been prevented under optimal trauma care conditions. The aim of this study was to identify trauma-related preventable death (TRPD) within our institute by an external expert panel and to evaluate inter-panel reliability. Trauma-related deaths between the 1st of January 2020 and the 1st of February 2022 at the Amsterdam University Medical Centre were identified. The severely injured patients (injury severity score ≥ 16) were enrolled for preventability analysis by an external multidisciplinary panel, consisting of a trauma surgeon, anaesthesiologist, emergency physician, neurosurgeon, and forensic physician. Case descriptions were provided, and panellists were asked to classify deaths as non-preventable, potentially preventable, and preventable. Agreements between the five observers were assessed by Fleiss kappa statistics. In total 95 trauma-related deaths were identified. Of which 36 fatalities were included for analysis, the mean age was 55.3 years (± 24.5), 69.4% were male and 88.9% suffered blunt trauma. The mean injury severity score was 35.3 (± 15.3). Interobserver agreement within the external panel was moderate for survivability (Fleiss kappa 0.474) but low for categorical preventable death classification (Fleiss kappa 0.298). Most of the disagreements were between non-preventable or potentially preventable with care that could have been improved. Multidisciplinary panel review has a moderate inter-observer agreement regarding survivability and low agreement regarding categorical preventable death classification. A valid definition and classification of TRPD is required to improve inter-observer agreement and quality of trauma care.

To reject, or to accept? A study on radiographers’ perspectives on diagnostic radiographs

IntroductionThe overall reject rate (RR) of our newly set up Radiology department was an average of 14%, higher than the recommended 8% target and 10% threshold set by the American Association of Physicists in Medicine (AAPM). An analysis done to identify potential causes of a high RR suggested that radiographers might have been rejecting images of diagnostic value. A lack of consistency in the definition of a diagnostic value image amongst radiographers may be a possible cause in the higher overall RR. This study aims to investigate potential discrepancies among radiographers in defining a diagnostic radiograph. MethodsAn online survey composed of an image bank with a questionnaire was created, participants grade each image as either accepted or rejected. Fleiss Kappa was used to determine the level of agreement between the radiographers in accepting or rejecting the images in the image bank. ResultsTwenty radiographers with varying years of experience participated in this study. There was fair agreement amongst the radiographers’ judgements, k=.277 (95% CI, .277 to .278), p < .005. Individual kappa for the “Accept” and “Reject” categories were both 0.277. There is no significant difference in the agreement level across the junior (k=.278), intermediate (k=.371) and senior (k=.275) radiographers. ConclusionThe result suggests that there is discrepancy in the radiographers’ definition of a diagnostic radiograph and this misalignment of radiographers’ perception might be one of the underlying causes of high RR. Implications for practiceThis study has provided the researchers with a better insight on the underlying cause of the department high RR. By calibrating the radiographers’ definition of a diagnostic radiograph, it will help realign the radiographer's agreement on when a radiograph should be rejected. This will reduce the overall RR and patient's overall dose. A lower RR translates to a more efficient turnaround time in General Radiography services, ensuring quality service is provided without further strain on our limited resources.

Interobserver Agreement of visual and semi-quantitative methods in 99mTc-Methoxy-Isobuty-Isonitrile (MIBI) imaging for risk stratification of hypofunctional thyroid nodules.

99mTc-Methoxy-Isobuty-Isonitrile (MIBI) imaging is used for risk stratifications of hypofunctioning thyroid nodules (TNs). MIBI uptake in the nodular tissue is compared to the uptake in the paranodular thyroid tissue. MIBI imaging may be interpreted visually and/or semi-quantitatively. This study aimed to evaluate the interobserver agreement (IOA) of different methods of interpreting MIBI imaging (visual and semi-quantitative approaches). MIBI imaging data from 2018 to 2020 were collected. Four readers with varying work experience prospectively evaluated MIBI images (planar, SPECT/CT) visually and semi-quantitatively (Wash-Out Index (WOI)). After identifying the nodules on 99mTc-pertechnetate scintigram, the readers evaluated MIBI imaging data by using early, late, early-to-late, and SPECT late acquisitions. Region of interests (ROIs) were defined for semi-quantitative analysis and average counts were calculated using the WOI formula (by Campenni et al.) 1 2. IOA was assessed using Fleiss Kappa, Pearson correlation and Analysis of Variance (ANOVA). 23 patients with hypofunctioning nodules were included. Kappa analysis revealed an IOA of 0.57 for all readers for early imaging (moderate agreement); perfect matches were found in 57%. For late imaging, the IOA was 0.48 (moderate) for all, with perfect matches in 48%. The visual pattern (early-to-late) exhibited an IOA of 0.45 for all, with perfect matches in 57%. SPECT/CT evaluation showed an overall IOA of 0.44, with perfect matches in 48%. The semi-quantitative approach WOI yielded an overall result of 0.64 (good agreement) and perfect matches in 91%. The IOA for WOI was higher than for visual methods. The WOI is independent of the reader's experience level. Visual analysis requires a certain level of experience from the reader.

Automated magnetic resonance imaging-based grading of the lumbar intervertebral disc and facet joints.

Degeneration of both intervertebral discs (IVDs) and facet joints in the lumbar spine has been associated with low back pain, but whether and how IVD/joint degeneration contributes to pain remains an open question. Joint degeneration can be identified by pairing T1 and T2 magnetic resonance imaging (MRI) with analysis techniques such as Pfirrmann grades (IVD degeneration) and Fujiwara scores (facet degeneration). However, these grades are subjective, prompting the need to develop an automated technique to enhance inter-rater reliability. This study introduces an automated convolutional neural network (CNN) technique trained on clinical MRI images of IVD and facet joints obtained from public-access Lumbar Spine MRI Dataset. The primary goal of the automated system is to classify health of lumbar discs and facet joints according to Pfirrmann and Fujiwara grading systems and to enhance inter-rater reliability associated with these grading systems. Performance of the CNN on both the Pfirrmann and Fujiwara scales was measured by comparing the percent agreement, Pearson's correlation and Fleiss kappa value for results from the classifier to the grades assigned by an expert grader. The CNN demonstrates comparable performance to human graders for both Pfirrmann and Fujiwara grading systems, but with larger errors in Fujiwara grading. The CNN improves the reliability of the Pfirrmann system, aligning with previous findings for IVD assessment. The study highlights the potential of using deep learning in classifying the IVD and facet joint health, and due to the high variability in the Fujiwara scoring system, highlights the need for improved imaging and scoring techniques to evaluate facet joint health. All codes required to use the automatic grading routines described herein are available in the Data Repository for University of Minnesota (DRUM).

The accuracy of Gemini, GPT-4, and GPT-4o in ECG analysis: A comparison with cardiologists and emergency medicine specialists

IntroductionGPT-4, GPT-4o and Gemini advanced, which are among the well-known large language models (LLMs), have the capability to recognize and interpret visual data. When the literature is examined, there are a very limited number of studies examining the ECG performance of GPT-4. However, there is no study in the literature examining the success of Gemini and GPT-4o in ECG evaluation. The aim of our study is to evaluate the performance of GPT-4, GPT-4o, and Gemini in ECG evaluation, assess their usability in the medical field, and compare their accuracy rates in ECG interpretation with those of cardiologists and emergency medicine specialists. MethodsThe study was conducted from May 14, 2024, to June 3, 2024. The book “150 ECG Cases” served as a reference, containing two sections: daily routine ECGs and more challenging ECGs. For this study, two emergency medicine specialists selected 20 ECG cases from each section, totaling 40 cases. In the next stage, the questions were evaluated by emergency medicine specialists and cardiologists. In the subsequent phase, a diagnostic question was entered daily into GPT-4, GPT-4o, and Gemini Advanced on separate chat interfaces. In the final phase, the responses provided by cardiologists, emergency medicine specialists, GPT-4, GPT-4o, and Gemini Advanced were statistically evaluated across three categories: routine daily ECGs, more challenging ECGs, and the total number of ECGs. ResultsCardiologists outperformed GPT-4, GPT-4o, and Gemini Advanced in all three groups. Emergency medicine specialists performed better than GPT-4o in routine daily ECG questions and total ECG questions (p = 0.003 and p = 0.042, respectively). When comparing GPT-4o with Gemini Advanced and GPT-4, GPT-4o performed better in total ECG questions (p = 0.027 and p < 0.001, respectively). In routine daily ECG questions, GPT-4o also outperformed Gemini Advanced (p = 0.004). Weak agreement was observed in the responses given by GPT-4 (p < 0.001, Fleiss Kappa = 0.265) and Gemini Advanced (p < 0.001, Fleiss Kappa = 0.347), while moderate agreement was observed in the responses given by GPT-4o (p < 0.001, Fleiss Kappa = 0.514). ConclusionWhile GPT-4o shows promise, especially in more challenging ECG questions, and may have potential as an assistant for ECG evaluation, its performance in routine and overall assessments still lags behind human specialists. The limited accuracy and consistency of GPT-4 and Gemini suggest that their current use in clinical ECG interpretation is risky.

Using Immersive Virtual Reality to Classify Pediatric Thoracolumbar Spine Injuries.

Objective This study aimed to assess the reliability and reproducibility of the AO Spine Thoracolumbar Injury Classification System by using virtual reality (VR). We hypothesized that VR is a highly reliable and reproducible method to classify traumatic spine injuries. Methods VR 3D models were created from CT scans of 26 pediatric patients with thoracolumbar spine injuries. Seven orthopedic trainees were educated on the VR platform and AO Spine Thoracolumbar Injury Classification System. Classifications were summarized by primary class and subclass for both rater readings performed two weeks apart with image order randomized. Intra-observer reproducibility was quantified by Fleiss's kappa (kF) for primary classifications and Krippendorff's alpha (aK) for subclassifications along with 95% confidence intervals (CIs) for each rater and across all raters. Inter-observer reliability was quantified by kFfor primary classifications and aKfor subclassifications along with 95% CIs across all raters for the first read, the second read, and all reads combined. The interpretations were as follows: 0-0.2: slight; 0.2-0.4: fair; 0.4-0.6: moderate; 0.6-0.8: substantial; and >0.8: almost perfect agreement. Results A total of 364 classifications were submitted by seven raters. Intra-observer reproducibility ranged from moderate (kF=0.55) to almost perfect (kF=0.94) for primary classifications and from substantial (aK=0.68) to almost perfect (aK=0.91) for subclassifications. Reproducibility was substantial across all raters for the primary class (kF=0.71; 95% CI=0.61-9.82) and subclass (aK=0.79; 95% CI=0.69-0.86). Inter-observer reliability was substantial (kF=0.63; 95% CI=0.57-0.69) for the first read, moderate (kF=0.58; 95% CI=0.52-0.64) for the second read, and substantial (kF=0.61; 95% CI=0.56-0.65) for all reads for primary classifications. For subclassifications, inter-observer reliability was substantial (aK=0.74; 95% CI=0.58-0.83) for the first read, second read (aK=0.70; 95% CI=0.53-0.80), and all reads (aK=0.72; 95% CI=0.60-0.79). Conclusions Based on our findings, VR is a reliable and reproducible method for the classification of pediatric spine trauma, besides its ability to function as an educational tool for trainees. Further research is needed to evaluate its application for other spine conditions.

Reliability of Angle Measurements Based on the Epiphyseal Scar for Knee Osteotomy: An International Multicenter Radiographic Study.

The proximal tibial epiphyseal inclination can be used as a prognostic factor for good results after knee osteotomy and measured using the tibial bone varus angle (TBVA). This angle depends on the visibility of the epiphyseal plate, which has shown poor reproducibility when measured on standard radiographs by conventional methods. To evaluate the measurement reliability of the TBVA and other angles based on the epiphyseal scar using a digital image display. Cohort study (diagnosis); Level of evidence, 3. A total of 100 whole-leg radiographs were analyzed twice by 3 orthopaedic surgeons from 2 countries in a blinded and randomized manner. Observers measured the hip-knee-ankle angle, mechanical lateral distal femoral angle, medial proximal tibial angle, and TBVA. The growth plate-tibial plateau (GPTP) angle, defined as the angle between the epiphyseal scar and tibial plateau, was measured; this angle has not yet been described for osteotomy. In addition, a modified version of the TBVA (mTBVA), defined as that between the epiphyseal scar, its center, and the center of the talus, was measured. The Ahlbäck score for osteoarthritis and a 3-grade score for epiphyseal scar visibility were also determined. The reliability of the angle measurements and scoring was evaluated using the Fleiss kappa and intraclass correlation coefficient (ICC). The scores for epiphyseal scar visibility showed fair interobserver (Fleiss kappa correlation coefficient [κ] = 0.29-0.35) and strong intraobserver (Fleiss κ = 0.62-0.69) reliability. TBVA, GPTP angle, and mTBVA measurements showed good interobserver reliability (ICC, 0.76-0.77), while the GPTP angle achieved excellent intraobserver reliability (ICC, >0.9). Using digital image display, angles that depend on the epiphyseal scar-such as TBVA, GPTP angle, and mTBVA-can achieve acceptable measurement reliability despite the low agreement on the visibility of the epiphyseal scar.

Inter-rater and intrarater reliability of superior labrum anterior to posterior lesion classification using magnetic resonance arthrography

BackgroundThe glenoid labrum is a fibrocartilaginous ring that affixes the joint capsule and ligaments of the glenohumeral joint2. Superior labrum anterior to posterior (SLAP) lesions are a subset of injuries that affect the superior glenoid labrum, most common in laborers and overhead-throwing athletes11. In 1990, Snyder et al classified SLAP lesions into one of four types10. Later, Maffet et al expanded this scale to include three additional subclassifications8. At present, arthroscopy is considered the gold standard for SLAP tear diagnosis5. Classification under arthroscopy has demonstrated low to moderate inter-rater reliability3. MRa is an alternate, less invasive test for diagnosing SLAP lesions. The reliability of MRa for diagnosing slap tears is uncertain. MethodsMR arthrograms were identified using the Picture Archiving and Communication System (PACS). In total, 273 shoulder arthrograms were reviewed, and 20 were selected with the desired pathology. Three orthopedic surgeons and three musculoskeletal radiologists were asked to classify the SLAP lesions into one of seven categories (Snyder & Maffet classification systems). Data was collected on two separate occasions at an interval of at least two months. Inter- and intra-rater reliability were calculated using Fleiss Kappa and Cohen's Kappa, respectively. ResultsBetween all raters, there was poor inter-rater reliability for each round of data collection (κ = .177, κ = .124 for rounds 1 and 2, respectively). Between orthopedic surgeons, there were poor levels of agreement (κ = -.056, κ = .114), whereas, between radiologists, there was fair to moderate agreement (κ = 0.479, κ = 0.340). Within orthopedic raters, κ values ranged from -0.059 to 0.125, indicating, at best, poor intra-rater reliability. Within radiologists, κ values ranged from 0.545 to 0.553, indicating moderate agreement within raters. The analysis determined that none of the orthopedic values for inter or intra-rater reliability could be deemed statistically different from zero. ConclusionOverall, classification using MRa resulted in significant disagreement between and within raters. Trained radiologists demonstrated higher overall levels of agreement than orthopedic surgeons. In summary, when using MRa to assess SLAP lesions, Snyder and Maffet classification demonstrates poor reliability by orthopedic surgeons and moderate reliability when used by musculoskeletal radiologists.

Intracapsular neck of femur fractures secondary to civilian gunshot injuries: an inter- and intra-observer agreement study on classification and treatment using the AO/OTA classification

PurposeNumerous classification systems have been developed for neck of femur fractures, but none have been tested for reliability in gunshot injuries. Our primary objective was to assess the inter-observer and intra-observer reliability of the AO/OTA classification system when applied to intracapsular neck of femur fractures secondary to low-velocity civilian gunshots wounds (GSWs). Our secondary objective was to test the reliability of the AO/OTA classification system in guiding surgeon treatment choices for these fractures.Patients and methodsEighteen reviewers (six orthopaedic traumatologists, six general orthopaedic surgeons and six junior orthopaedic fellows) were given a set of 25 plain radiographs and CT scans of femur neck fractures secondary to GSW. For each clinical case, all reviewers selected a classification as well as treatment option from a list of given options. Inter-observer reliability was measured at the initial classification. The exercise was repeated 10–12 weeks later by the same 18 reviewers to test intra-observer reliability.ResultsThe Fleiss kappa values indicate only slight agreement amongst raters, across all experience levels, for both injury classification and treatment. Intra-observer agreement was fair across all experience levels for both injury classification and treatment.ConclusionThe AO/OTA classification showed only slight reliability in classification of gunshot fractures of the femur neck. With only fair reliability, it also failed to guide surgical treatment thus rendering its routine use in daily clinical practice of questionable value.

Cross-cultural adaptation, reliability, and validity of the Turkish Pediatric Quality of Life Inventory-Cognitive Functioning Scale (PedsQLTM-CFS) in children with cancer

ABSTRACT The Pediatric Quality of Life Inventory-Cognitive Functioning Scale (PedsQLTM-CFS) was developed as a brief, general, symptom-specific tool to measure cognitive function. The 6-item PedsQL™ Cognitive Functioning Scale and PedsQL 3.0 Cancer Module answered 369 parents and 330 children with 5–18 years. Parents also completed Behavior Rating Inventory of Executive Function (BRIEF). The PedsQL™ Cognitive Functioning Scale evidenced excellent reliability (parent proxy-report α = 0.980/Fleiss Kappa: 0.794; children self-report α = 0.963/Fleiss Kappa: 0.790). Both child self-report and parent proxy-report PedsQL™ Cognitive Functioning Scale scores exhibited significant correlations with all parent-report BRIEF summary and subscale scores (p < .05). Both child self-report and parent proxy-report PedsQL™ Cognitive Functioning Scale scores exhibited significant correlations with PedsQL 3.0 Cancer Module total score and subscale scores (p < .05). The PedsQLTM-CFS can be used in high-risk populations with substantial to perfect reliability, both in regards to total/subcategory scores as well as in children with cancer.

Decoding the Prevalent High-Risk Breast Cancers: Demographics, Pathological, Imaging Insights, and Long-Term Outcome.

Objective: To investigate the features and outcomes of breast cancer in high-risk subgroups. Materials and Methods: REB approved an observational study of women diagnosed with breast cancer from 2010 to 2019. Three radiologists, using the BI-RADS lexicon, blindly reviewed mammogram and MRI screenings without a washout period. Consensus was reached with 2 additional reviewers. Inter-rater agreement was measured by Fleiss Kappa. Statistical analysis included Mann-Whitney U, Chi-square tests for cohort analysis, and Kaplan-Meier for survival rates, with a Cox model for comparative analysis using gene mutation as a reference. Results: The study included 140 high-risk women, finding 155 malignant lesions. Significant age differences noted: chest radiation therapy (median age 44, IQR: 37.0-46.2), gene mutation (median age 49, IQR: 39.8-58.0), and familial risk (median age 51, IQR: 44.5-56.0) (P = .007). Gene mutation carriers had smaller (P = .01), higher-grade tumours (P = .002), and more triple-negative ER- (P = .02), PR- (P = .002), and HER2- (P = .02) cases. MRI outperformed mammography in all subgroups. Substantial to near-perfect inter-rater agreement observed. Over 10 years, no deaths occurred in chest radiation group, with no significant survival difference between gene mutation and familial risk groups, HR = 0.93 (95% CI: 0.27, 3.26), P = .92. Conclusion: The study highlights the importance of age and specific tumour characteristics in identifying high-risk breast cancer subgroups. MRI is confirmed as an effective screening tool. Despite the aggressive nature of cancers in gene mutation carriers, early detection is crucial for survival outcomes. These insights, while necessitating further validation with larger studies, advocate for a move toward personalized medical care, strengthening the existing healthcare guidelines.

Wearing surgical face mask has no significant impact on auscultation assessment.

During the COVID-19 pandemic, universal mask-wearing became one of the main public health interventions. Because of this, most physical examinations, including lung auscultation, were done while patients were wearing surgical face masks. The aim of this study was to investigate whether mask wearing has an impact on pulmonologist assessment during auscultation of the lungs. This was a repeated measures crossover design study. Three pulmonologists were instructed to auscultate patients with previously verified prolonged expiration, wheezing, or crackles while patients were wearing or not wearing masks (physician and patients were separated by an opaque barrier). As a measure of pulmonologists' agreement in the assessment of lung sounds, we used Fleiss kappa (K). There was no significant difference in agreement on physician assessment of lung sounds in all three categories (normal lung sound, duration of expiration, and adventitious lung sound) whether the patient was wearing a mask or not, but there were significant differences among pulmonologists when it came to agreement of lung sound assessment. Clinicians and health professionals are safer from respiratory infections when they are wearing masks, and patients should be encouraged to wear masks because our research proved no significant difference in agreement on pulmonologists' assessment of auscultated lung sounds whether or not patients wore masks.