Interobserver Kappa Research Articles

Destructive spondyloarthropathy of the lumbar spine in patients on long-term haemodialysis: a computed tomography-based study.

Destructive spondyloarthropathy (DSA) is a serious complication of long-term haemodialysis; it commonly occurs in the cervical spine and has been investigated in cervical lesions. Although DSA of the lumbar spine has been reported, only few studies have investigated this, and the characteristics of patients with lumbar DSA are unclear. The present study aimed to elucidate the prevalence of DSA and its clinical characteristics in patients with DSA in the lumbar spine using computed tomography (CT) images of the patients who underwent lumbar spine surgery. Consecutive patients undergoing haemodialysis who underwent lumbar spine surgery (n = 67) were assessed. DSA was diagnosed using CT images, and the patients were divided into non-DSA and DSA groups. The differences in the clinical characteristics of the patients in the two groups were analysed. The prevalence of patients diagnosed with DSA was 31.3%. The mean intra- and inter-observer kappa values of DSA classification using CT images were 0.68 and 0.53, respectively. Although there were no significant differences in the age, sex, body mass index, reason for lumbar surgery, disease causing haemodialysis, age at the start of haemodialysis, or duration of haemodialysis between the non-DSA and DSA groups, the duration of haemodialysis tended to be longer in the DSA group. Among patients on haemodialysis who underwent lumbar spine surgery, the prevalence of patients with DSA was 31.3%. Classification of DSA using CT showed moderate-to-substantial agreement. Patients with DSA tended to have a longer haemodialysis duration.

Three-Dimensional Volume Ultrasound Assessment of Cesarean Scar Niche and Cervix in Pregnant Women: A Reproducibility Study.

To assess the reproducibility of standardized 3-dimensional (3D) ultrasound volume analysis of the dimensions and the position of cesarean birth (CB) scar niche relative to the cervix in pregnant women. This prospective single-center study in women with 1 previous CB ≥8 cm cervical dilatation acquired ultrasound volumes between 11 and 24 weeks' gestation in a mid-sagittal plane. Two experienced operators processed the volumes using virtual organ computer-aided analysis. A CB scar niche was defined as an indentation at the scar site of ≥2 mm in depth. Niche and cervix volumes were calculated using manual contouring. Agreement for categorical variables was expressed using intraclass correlation coefficient (ICC). The Bland-Altman method was used to assess numerical variable reproducibility. To achieve the desired statistical power, 52 participants were included. The intraobserver agreement on niche classification relative to the internal os was 100%, with an interobserver kappa coefficient of 0.98 (95% confidence interval [CI] 0.97-0.99, P < .05). The intraobserver ICC for niche volume was 0.94 (95% CI 0.90-0.96; P < .001), with a mean difference of -15.32 mm3 (±109.32). The interobserver ICC was 0.78 (95% CI 0.62-0.87; P < .001), with a mean difference of -21.57 mm3 (±202.01). The ICC for niche/cervix volume ratio were 0.94 (95% CI 0.90-0.96; P < .001) and 0.79 (95% CI 0.63-0.87; P < .001) for intra- and interobserver reproducibility, respectively. This study demonstrates that 3D CB scar sonographic features are highly reproducible in pregnant women with a history of advanced labor CB. The validated protocol can guide future research on the association with subsequent adverse pregnancy outcomes.

Sound transmission using a tuning fork for the diagnosis of developmental dysplasia of the hip in newborns.

This study aims to estimate the validity and reliability of sound transmission tests using a tuning fork and stethoscope compared with the usual clinical procedures for the diagnosis of developmental dysplasia of the hip in newborns from the state of Guanajuato, Mexico. This is a cross-sectional study of newborns at the Guanajuato General Hospital of the Institute of Public Health from Guanajuato. The population under study comprised newborns born from April to May 2023. All parents of newborns were invited to participate. The Ortolani, Barlow, Peter-Baden, and sound transmission tests were performed with a tuning fork and stethoscope three times by two observers. Ultrasonography using the Graf technique was also applied to both hips. We evaluated the validity and repeatability of clinical procedures and sound transmission tests against ultrasonography as the gold standard. We calculated sensitivity, specificity, and predictive values for validity and Cohen's kappa for repeatability. The sample consisted of 100 newborns (56% male and 44% female); 65% born by vaginal delivery. Sound transmission test results for sensitivity, specificity, the positive predictive value, and the negative predictive value were 87.88%, 95.81%, 80%, and 97.53%, respectively. The intra-observer kappa was 0.89 (95% CI = 0.80-0.97) and the inter-observer kappa was 0.85 (95% CI = 0.73-0.97). The validity and repeatability of the Ortolani, Barlow, and Peter-Baden tests were low compared with the sound transmission test. The sound transmission test using a tuning fork and stethoscope is helpful for the diagnosis of developmental dysplasia of the hip.

The Validity and Reliability of CT Scan Based Tibial Plateau Mapping for Tibial Plateau Fractures

Abstract Background Tibial plateau fractures are intra-articular fractures presume a threat to knee function and represent great challenge to treat. Treatment with open reduction and internal fixation is variable because fractures vary from simple to complex, with little or extensive articular involvement. Hence, recognition of the fracture features will help orthopedic surgeons to understand the injury mechanism better and manage these fractures by planning optimal surgical procedures. Aim of the Work To assess the inter and intra-observer reliability of the new CT scan based tibial plateau classification (the ten segment tibial plateau mapping) and the secondary aim is to clarify its validity in clinical practice assisting the surgeons in choosing their approach and fixation implant during open reduction and internal fixation of such fractures. Our hypothesis is that this more sophisticated classification system may facilitate the choice of surgical approach and implants used and that this classification could be widely accepted among trauma surgeons. Patients and Methods A total of 30 patients with tibial plateau fractures diagnosed by the department of orthopedic surgery at el Demerdash hospital, Ain Shams university were collected in the time period between January 2020 and December 2022. Results in our study, we compared the inter and intra observer reliability of Schatzker, three column, and ten-segment classification using Kappa values. The results showed that schatzker and three column classification systems have higher inter-observer mean kappa values (0.749± 0.07, 0.692± 0.08) (0.639± 0.06, 0.667± 0.08 after 2 weeks‟ time interval) respectively representing good interobserver agreement in relation to the ten-segment classification which showed mean Kappa value 0.409± 0.30 representing moderate interobserver agreement when the cases were observed for the first time. The mean Kappa value decreased (0.081± 0.17) when the cases were observed after 2 weeks‟ time interval representing poor interobserver agreement. As regard to intra-observer reliability, both schatzker and three column classifications have higher mean Kappa values (0.766± 0.22, 0.697± 0.17 respectively) representing good intra-observer agreement in relation to ten segment classification which showed mean Kappa value (0.342± 0.10) representing poor intra-observer agreement. Conclusion tibial plateau fractures represent great challenge for orthopedic surgeons to treat and adequate preoperative planning is mandatory. The use CT scan with 3D reconstruction can help surgeons to describe and classify all fracture patterns thus reaching the optimal plane for fracture fixation. Our study concluded that ten segment classification has moderate to poor reliability compared to the conventional widely used schatzker classification and three column classification. We think that this because ten segment classification still not familiar to orthopedic surgeon. More research is needed on ten segment classification so that it can be applied in the future in clinical practice.

Developing and evaluating a mobile-based teledermatology system for skin lesion diagnosis in Iran

Asynchronous teledermatology (TD) has shown promise in improving access to dermatological care, yet studies reveal varied methodologies and results. This study aimed to design a mobile app using the store-and-forward model, marking a pioneering effort in Iran to facilitate written documentation of patient history and skin lesion imagery for accurate diagnosis. Conducted from July 2022 to July 2023, this study involved the development and implementation of a smartphone app to collect clinical data and photographs from 89 patients at a dermatology clinic. Diagnoses made at the clinic served as the gold standard. Three dermatologists independently reviewed the app-recorded data, providing diagnoses that were compared to in-person assessments using the Kappa coefficient and agreement percentage. Lesions were predominantly located on the whole body (47%), with psoriasis (19.1%), acne vulgaris (11.2%), and eczema (10%) being the most common. The overall inter-observer Kappa value demonstrated excellent agreement at 0.856. The study's findings endorse the use of a mobile app for TD as an effective adjunct in regions with scarce dermatological services, such as Iran. To promote the broader application of TD, ongoing research is essential to further establish its reliability and practicality.

Could near focus endoscopy, narrow-band imaging, and acetic acid improve the visualization of microscopic features of stomach mucosa?

Conventional magnifying endoscopy with narrow-band imaging (NBI) observation of the gastric body mucosa shows dominant patterns in relation to the regular arrangement of collecting venules, subepithelial capillary network, and gastric pits. To evaluate the effectiveness of a new one-dual (near) focus, NBI mode in the assessment of the microscopic features of gastric body mucosa compared to conventional magnification. During 2021 and 2022, 68 patients underwent proximal gastrointestinal endoscopy using magnification endoscopic modalities subsequently applying acetic acid (AA). The GIF-190HQ series NBI system with dual focus capability was used for the investigation of gastric mucosa. At the time of the endoscopy, the gastric body mucosa of all enrolled patients was photographed using the white light endoscopy (WLE), near focus (NF), NF-NBI, AA-NF, and AA-NF-NBI modes. The WLE, NF and NF-NBI endoscopic modes for all patients (204 images) were classified in the same order into three groups. Two images from each patient for the AA-NF and AA-NF-NBI endoscopic modes were classified in the same order. According to all three observers who completed the work independently, NF magnification was significantly superior to WLE (P < 0.01), and the NF-NBI mode was significantly superior to NF magnification (P < 0.01). After applying AA, the three observers confirmed that AA-NF-NBI was significantly superior to AA-NF (P < 0.01). Interobserver kappa values for WLE were 0.609, 0.704, and 0.598, respectively and were 0.600, 0.721, and 0.637, respectively, for NF magnification. For the NF-NBI mode, the values were 0.378, 0.471, and 0.553, respectively. For AA-NF, they were 0.453, 0.603, and 0.480, respectively, and for AA-NF-NBI, they were 0.643, 0.506, and 0.354, respectively. When investigating gastric mucosa in microscopic detail, NF-NBI was the most powerful endoscopic mode for assessing regular arrangement of collecting venules, subepithelial capillary network, and gastric pits among the five endoscopic modalities investigated in this study. AA-NF-NBI was the most powerful endoscopic mode for analyzing crypt opening and intervening part.

Cinematic rendering improves the AO/OTA classification of distal femur fractures compared to volume rendering: a retrospective single-center study.

Purpose: Correctly classifying distal femur fractures is essential for surgical treatment planning and patient prognosis. This study assesses the potential of Cinematic Rendering (CR) in classifying these fractures, emphasizing its reported ability to produce more realistic images than Volume Rendering (VR). Methods: Data from 88 consecutive patients with distal femoral fractures collected between July 2013 and July 2020 were included. Two orthopedic surgeons independently evaluated the fractures using CR and VR. The inter-rater and intra-rater agreement was evaluated by using the Cicchetti-Allison weighted Kappa method. Accuracy, precision, recall, and F1 score were also calculated. Diagnostic confidence scores (DCSs) for both imaging methods were compared using chi-square or Fisher's exact tests. Results: CR reconstruction yielded excellent inter-observer (Kappa = 0.989) and intra-observer (Kappa = 0.992) agreement, outperforming VR (Kappa = 0.941 and 0.905, respectively). While metrics like accuracy, precision, recall, and F1 scores were higher for CR, the difference was not statistically significant (p > 0.05). However, DCAs significantly favored CR (p < 0.05). Conclusion: CR offers a superior visualization of distal femur fractures than VR. It enhances fracture classification accuracy and bolsters diagnostic confidence. The high inter- and intra-observer agreement underscores its reliability, suggesting its potential clinical importance.

Curds in the way: A milk curd obstruction review and normal sonographic bowel appearances using a novel scoring system in neonates on fortified breast milk feeds.

Fortified expressed breast milk (FEBM) is a standard of care for premature and low birth weight neonates, but comes with an elevated risk of a rare but re-emergent pathology called milk curd obstruction (MCO). Little is known about normal sonographic appearances of bowel contents in this feeding setting, making the recognition of abnormalities difficult. Thus, we aimed to describe appearances that may be considered typical pre- and post-fortifier inclusion. Ten neonates of <32 weeks' gestation or a birth weight of <1,800 g recruited from Auckland City Hospital Neonatal Intensive Care between 1/5/2019 and 10/9/2019 received bowel ultrasounds within 24 h before and 10-14 days after starting FEBM. Bowel contents in six abdominal regions were assigned scores of 1-6 based on increasing solidification. Lower gestational age was correlated with more solid contents on the pre-fortifier ultrasound (P = 0.02). Fortifier was significantly associated with increasing solidity, particularly in the left abdomen (P < 0.001). The left lower quadrant and rectum accounted for much of this change (P = 0.012 and P = 0.002). One subject who subsequently developed a clinical picture consistent with early MCO had uniquely demonstrated non-rectal solid contents (score 6). The interobserver kappa score for two assessors was 0.91 (95% CI 0.94-0.99) on still images. This small cohort demonstrated increasing bowel content solidification after breast milk fortification using a novel ultrasound scoring system with good interobserver agreement. Non-rectal solid contents (score 6) appeared atypical. Ultrasound shows promise for its non-irradiating diagnostic utility in the setting of early milk curd disease evaluation of the premature neonate.

Imaging Classification by Column and Type of the Generalized Distal Radius Die-punch Fractures

Background:: Generalized distal radius die-punch fractures (GDP) can involve three columns. However, there is no three-column classification for GDP. The aim of this study was to introduce a three-column classification for GDP, and to investigate the application effect of the classification. Methods:: 613 patients with GDP accrued from January 2013 to December 2021 were classified by column and fracture type based on imaging findings. First, the GDP was categorized into single-, double-, or three-column fractures. Second, the intermediate column fractures were divided into volar, dorsal, split, collapse, or mixed types; the radial column fractures were divided into metaphyseal, articular or mixed types; and the ulnar column fractures were divided into apical or basal types of the styloid process. The intra- and inter-observer consistency between the two assessors was analyzed with kappa statistics. 227 patients with less fracture displacement were treated conservatively, whereas 386 patients with increased fracture displacement were treated surgically, and the selection of surgical approaches and fracture reduction-fixation methods was guided by the classification. The differences in incidence, gender, age, treatment methods, and functional recovery were compared among the three categories, and the characteristics of different types were observed. The wrist joint function was evaluated according to the Sarmiento-modified Gartland- Werley method. Results:: The intra- and the inter-observer kappa coefficients were obtained as ≥ 0.810. There were significant differences in the incidence (12.7%, 68.5%, and 18.8%, respectively) and age (39.8, 46.6, and 47.1 years, respectively) for single-, double- and three-column fractures (P&lt;0.05). However, there was no significant difference in terms of gender among the three (P&gt;0.05). The mixed, collapse, split, dorsal, and volar types accounted for 28.7%, 27.7%, 21.9%, 15.5%, and 4.5%, respectively. The metaphyseal, articular surface, and mixed types accounted for 35.9%, 33.1%, and 31.0%, respectively. The apical and base types were 81.7% and 18.3%, respectively. Among the cases of volar and dorsal types, the missed diagnosis rate of X-ray alone was 28.5%, but it was confirmed by subsequent CT. In the last follow-up of 12.2 months (range, 6 to 24 months), the excellent plus good rate was 82.7% and 82.6%, respectively, in total and among patients undergoing surgical treatment; the excellent plus good rate of the single column fractures was 96.2%, significantly higher than that of double- and three-column fractures (80.0% and 83.5%, respectively) (P&lt;0.05). All patients with fair or poor wrist function had collapse or mixed-type intermediate column fractures. Conclusion:: Different categories/types of GDP have significant differences in terms of incidence, age, efficacy, and prognosis. Imaging classification by column and type of GDP better reflects the features and injury mechanism of the fractures with good consistency. Therefore, it has important reference value for the surgical modality and prognosis evaluation.

Pericoronary adipose tissue attenuation predicts outcome of percutaneous intervention for chronic total occlusion

To investigate the association between pericoronary adipose tissue (PCAT) attenuation (PCATA) and outcomes of chronic total occlusion (CTO) after percutaneous coronary intervention (PCI), and to establish a clinical model that can be easily generalised to predict the outcomes of PCI-CTO. Between September 2015 and September 2019, patients from two centres were enrolled retrospectively. The primary endpoint was a procedural success (defined as achieving residual stenosis of <30% and a grade 3 thrombolysis in myocardial infarction [TIMI] flow). The new predictive model was generated by factors that were determined by multivariate analysis. The PCATA of CTO (PCATA-CTO) score was developed by assigning 1 point for each independent predictor, and then summing all points accrued. In addition, the predictive efficacy and interobserver and intraobserver agreement of PCATA-CTO and other scoring systems based on coronary computed tomography angiography (CCTA) were compared. A total of 201 patients (mean age 58.9±10.8 years, 85% male) were enrolled. The PCI success was achieved in 76% of the lesions. PCAT was higher in the PCI success group (-72.44±10.45HU versus -76.76±10.54 HU, p<0.05). Multivariable analysis yielded severe calcification, lesion length ≥15 mm, and perivascular fat attenuation index (FAI) ≤-69.5HU as independent negative predictors for procedural success. The area under the receiver operating characteristic curves for the PCATA-CTO score was 0.72. Comparing the PCATA-CTO score with other predictive scores, the PCATA-CTO score showed the highest interobserver (kappa=0.74) and intraobserver agreement (kappa=0.90, all p<0.01). FAI ≤-69.5HU is an independent negative predictor of procedural success. The PCATA-CTO score improved the reliability of the prediction model. Its potential for clinical implementation requires evaluation.

The Influence of Computerized Tomography Imaging on Treatment of Periprosthetic Proximal Femur Fractures.

Introduction Periprosthetic femur fractures (PPFF) are increasing in incidence and management of such injuries requires a specialized skill set combined with detailed knowledge of component design. To assist with planning, computed tomography (CT) can beusedpre-operatively to give a surgeon more information. No study to date has shown the utility of obtaining preoperative CT. The goal of this study is to show that CT is a useful diagnostic adjunct and report any differences in how subspecialties such as orthopedic traumatologists and arthroplasty surgeonsuse it. Methods Seventeen PPFF cases met our inclusion criteria.They were shown to six faculty, three trauma and three arthroplasty surgeons. They viewed the plain radiographs and then CTs. After each they filled out the same questionnaire that included their assessment of diagnosis and proposed treatment plan both before and after access to CT imaging. Fleiss and Cohen kappa were used to compare inter- and intra-observer reliability. Results The interobserver kappa values (k) in diagnosis were 0.348 pre- and 0.371 post-CT, while trauma and arthroplasty were 0.328 to 0.260 and 0.821 to 0.881 respectively. The interobserver reliability in treatment was 0.336 pre- and 0.254 post-CT, while trauma and arthroplasty were 0.323 to 0.288 and 0.688 to 0.519. For intraobserver the average k for diagnosis and treatment were 0.818 and 0.671. Broken down by subspecialty they were 0.874 and 0.831 and 0.762 and 0.510 for trauma and arthroplasty. There were 11 diagnostic and 24 treatment changes. Conclusion CT provides diagnostic changes 10% and treatment changes 24% of the time. However, it does not lead to greater agreement among the surgeons on either. Arthroplasty uses CT more to guide both their treatment and the diagnosis, and they agree more than trauma surgeons. Most of the treatment changes come from adding or removing a plate, and the most common diagnostic change was shared by A to B1 and B2 to B3. This suggests fracture extension and bone stock are better evaluated by CT.

Clinical application value of modified Lee grading system to evaluate the degree of foraminal stenosis in patients with intervertebral foraminal lumbar disc herniation

Objective: To investigate the clinical application value of the modified Lee grading system (abbreviated as the modified system) in evaluating the degree of intervertebral foraminal stenosis(IFS) in patients with foraminal lumbar disc herniations(FLDH). Methods: MRI data of 83 patients with FLDH-IFS (34 patients in the operation group and 49 patients in the conservative group) in Yantai Affiliated Hospital of Binzhou Medical University and Yantai Yantaishan Hospital from March 2018 to February 2021 were retrospectively collected. There were 43 males and 40 females, ranged from 34 to 82 years old, with an average of (61±10) years. MRI images of selected patients were independently evaluated and recorded by two radiologists in a blind method, using both the Lee grading system (abbreviated as Lee system) and the modified system, respectively and each method was evaluated twice. The difference between the evaluation level of the two systems, and the agreement of observer assessments of the two systems were compared, and the correlation between the evaluation level of the two grading systems and the clinical treatment modalities was analyzed. Results: The percentage of nongrade 3 (grade 0-2) patients with effective conservative treatment according to the two grading systems was 94.6 % (139/147) and 64.2 % (170/265), respectively. The percentage of grade 3 patients requiring surgical treatment according to the two grading systems was 69.2 % (128/185) and 61.2 % (41/67), respectively. There was a statistically significant difference between the evaluation levels of the modified system and the Lee system (Z=-5.16, P=0.001). In the Lee system, the intra-observer observation consistency Kappa values of the two radiologists were 0.735 and 0.542, respectively, which were highly and moderately consistent; and the inter-observer observation consistency Kappa values were 0.426-0.521, which were moderate consistency. In the modified system, the intra-observer consistency Kappa values of the two radiologists were 0.900 and 0.921, respectively, and the consistency was almost completely consistent; and the inter-observer consistency Kappa values were 0.783-0.861, which were highly consistent or almost completely consistent. Lee system and clinical treatment modalities was correlative (rs=0.39,P<0.001), and modified system and clinical treatment modalities was correlative (rs=0.61,P<0.001). Conclusion: According to FLDH-IFS, the modified system can comprehensively and accurately grade, with high reliability and reproducibility. The evaluation level has a more significant correlation with clinical treatment modalities.

Is the Robinson classification of clavicle fractures accurate enough within the setting of the Swedish Fracture Register?

IntroductionIn the Swedish Fracture Register (SFR) clavicle fractures are classified according to the Robinson classification. This study aimed to evaluate the accuracy of the classification of clavicle fractures in the SFR. A secondary aim was to assess inter- and intraobserver agreement. Materials and MethodsClavicle fractures (n = 132) were randomly selected from the SFR and radiographs were requested for each patient from their treating departments. Not all radiographs could be acquired, and after exclusion, 115 fractures were independently classified by three expert raters blinded to patient information. The 115 fractures were classified on two occasions, 3 months apart. The raters’ consensus classification was used as a gold standard that was compared to the classification registered in the SFR. The accuracy, defined as the degree of agreement between the gold standard and SFR classifications, was reported, as was the inter- and intraobserver agreement for the expert raters. ResultsAgreement between the classification in the SFR and the gold standard classification was fair (kappa = 0.35). Fractures with only partial displacement were often incorrectly classified as fully displaced in the SFR (n = 31 of 78 displaced fractures in the SFR). The inter- and intraobserver agreement among the expert raters was almost perfect (interobserver kappa = 0.81–0.87, intraobserver kappa = 0.84–0.94). ConclusionsThe accuracy of the classification of clavicle fractures in the SFR was only fair, whereas the inter- and intraobserver agreement among the expert raters was almost perfect. Accuracy in the SFR may be improved if the classification instructions in the SFR are updated by incorporating the original classification displacement criteria, both in text and in illustrated form.

Reliability of Current Classification Systems for Periprosthetic Fractures of the Humerus.

Numerous classification systems exist to evaluate periprosthetic humerus fractures, although most are based on limited patient numbers. The Wright & Cofield system is the most widely used classification system. We sought to evaluate the inter-observer and intra-observer reliabilities of this system compared to the Unified Classification System (UCS) using the largest patient sample to date. This retrospective study identified patients between December 2011 and January 2021 with a periprosthetic fracture of the humerus around the stem of a shoulder arthroplasty component. Three upper extremity trained surgeons evaluated all radiographs for stem stability, evidence of pre-injury stem loosening, Wright & Cofield classification, UCS classification, and recommended treatment for each case at two timepoints separated by two months. The kappa statistic for inter-observer and intra-observer reliability was calculated. Seventy-six patients were included. There was moderate inter-observer (kappa 0.53) and substantial intra-observer (kappa 0.69) agreement when classifying stem stability after fracture. There was moderate inter-observer (kappa 0.48) and intra-observer (kappa 0.60) agreement when evaluating for stem loosening prior to fracture. There was fair inter-observer (kappa 0.29) and moderate intra-observer (kappa 0.51) agreement regarding the UCS class. There was moderate inter-observer (kappa 0.41) and intra-observer (kappa 0.57) agreement regarding the proposed treatment. There was slight inter-observer (kappa 0.04) and moderate intra-observer (kappa 0.44) agreement regarding the Wright & Cofield classification. The Wright & Cofield system is less reliable than the UCS classification. A more reliable and clinically relevant classification system is needed to standardize discussion of periprosthetic proximal humerus fractures. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

The Reliability of the Tönnis Grading System in Patients Undergoing Hip Preservation

Background: The presence of pre-existing osteoarthritis (OA) has been associated with poor results after hip arthroscopic surgery. There is limited evidence validating the currently available grading systems of hip OA in patients undergoing hip preservation. Purpose/Hypothesis: Our purpose was to evaluate the interobserver and intraobserver reliabilities of 2 grading systems in a group of patients undergoing hip preservation: the Tönnis grading system and a simple 4-choice Likert scale. The hypothesis was that interobserver and intraobserver reliabilities using the Tönnis grading system would be poor among surgeons experienced in hip preservation and that a 4-choice Likert scale would be more reliable. Study Design: Cohort study (diagnosis); Level of evidence, 3. Methods: A total of 100 hip radiographs were reviewed by 8 experienced hip preservation surgeons. Overall, 2 rounds of reviews were performed, at least 3 weeks apart, assessing for the presence, degree, and/or location of joint space narrowing, joint space asymmetry, subchondral cysts, osteophytes, and sclerosis. The radiographs were assigned a Tönnis grade as well as a Likert grade of OA, reported as none, mild, moderate, or severe. Statistical analysis was conducted to provide Fleiss kappa values with 95% CIs. Agreement was classified as poor for <0.00, slight for 0.00-0.20, fair for 0.21-0.40, moderate for 0.41-0.60, substantial for 0.61-0.80, and almost perfect for >0.80. Results: A total of 50 patients (28 female and 22 male) with a mean age of 42.8 ± 14.2 years (range, 19-70 years) were reviewed. The Tönnis grade demonstrated an interobserver kappa value of 0.30 (95% CI, 0.26-0.34). The Likert grade demonstrated an interobserver kappa value of 0.33 (95% CI, 0.28-0.37). All other measures demonstrated interobserver kappa values classified as slight or fair except for subchondral cysts which was moderate. Intraobserver reliabilities were statistically significantly higher than interobserver reliabilities. Intraobserver reliabilities for both the Tönnis grade (κ = 0.55 [95% CI, 0.51-0.60]) and Likert grade (κ = 0.59 [95% CI, 0.55-0.63]) demonstrated similar kappa values, consistent with moderate agreement. Subchondral cysts demonstrated the strongest interobserver (κ = 0.53) and intraobserver (κ = 0.85) reliabilities. Conclusion: Interobserver and intraobserver reliabilities were fair and moderate, respectively, for grading OA. Given the limited interobserver reliability, caution should be used when interpreting and translating studies that utilize the Tönnis grade or other rating to dictate treatment algorithms.

Cone beam computed tomography in the assessment of TMJ deformity in children with JIA: repeatability of a novel scoring system

BackgroundThe temporomandibular joint (TMJ) is frequently involved in juvenile idiopathic arthritis (JIA). Diagnostic imaging is necessary to correctly diagnose and evaluate TMJ involvement, however, hitherto little has been published on the accuracy of the applied scoring systems and measurements. The present study aims to investigate the precision of 20 imaging features and five measurements based on cone beam computed tomography (CBCT).MethodsImaging and clinical data from 84 participants in the Norwegian study on juvenile idiopathic arthritis, the NorJIA study, were collected. Altogether 20 imaging features and five measurements were evaluated independently by three experienced radiologists for intra- and interobserver agreement. Agreement of categorical variables was assessed by Fleiss’, Cohen’s simple or weighted Kappa as appropriate. Agreement of continuous variables was assessed with 95% limits of agreement as advised by Bland and Altman.Results“Overall impression of TMJ deformity” showed almost perfect intraobserver agreement with a kappa coefficient of 0.81 (95% CI 0.69–0.92), and substantial interobserver agreement (Fleiss’ kappa 0.70 (0.61–0.78)). Moreover, both “flattening” and “irregularities” of the eminence/fossa and condyle performed well, with intra- and interobserver agreements of 0.66–0.82 and 0.55–0.76, respectively. “Reduced condylar volume” and “continuity” of the fossa/eminence had moderate intra- and interobserver Kappa values, whereas continuity of the condyle had Kappa values above 0.55. Measurements of distances and angles had limits of agreement of more than 15% of the sample mean.ConclusionsWe propose a CBCT-based scoring system of nine precise imaging features suggestive of TMJ deformity in JIA. Their clinical validity must be tested.

A novel computed tomography-based three-column MLP classification of intertrochanteric fracture.

The aim of the present study was to introduce a novel three-dimensional computed tomography (3DCT)-based three-column classification (named "MLP classification system") of intertrochanteric fractures and evaluate its reproducibility and reliability. From September 2020 to September 2022, a total of 258 consecutive patients (60 male, 198 female;mean age 81.3 years) with intertrochanteric fractures were included in this study. The fracture in each case was assessed using a novel three-dimensional computed tomography-based three-column classification. Two examiners tested the intra and inter-observer reliability of this new classification system using kappa variance. The intertrochanteric region was divided into the medial column, lateral column, and posterior column. Intertrochanteric fractures were documented as M0/1/2L0/1/2/3P0/1/2/3. All fractures were classifiable into the new classification system. The intra-observer kappa values were 0.91 and 0.89, while the inter-observer kappa value was 0.82, both indicating almost perfect reliability. This novel 3DCT-based MLP classification system for intertrochanteric fractures is comprehensive, and reproducible with good agreement. It is based on proximal femur biomechanic characteristics and traumatic mechanism, contributing to formulating more reasonable treatment protocols involving various late-model internal fixation devices. J. Med. Invest. 70 : 524-529, August, 2023.

ODP411 Frequency of hyperandrogenism in Mexican adult women with type 1 diabetes mellitus: a pilot study.

Abstract Background Hyperandrogenism has been described with different frequencies in populations of women and adolescents with type 1 diabetes (T1D). Ethnic differences account for variation in genetic causes as well as clinical and metabolic parameters for diagnosis. We aimed to evaluate clinical, laboratory and imaging tests of a sample of adult women with T1D in order to calculate a valid sample size for further studies in our population, which presents a high prevalence of metabolic syndrome. Materials and methods we included the first patients from a group of 55 women with T1D between the ages of 18 and 45. Blood samples were performed in the early follicular phase and ultrasound in the follicular phase. Ferriman-Gallwey score was evaluated by two independent trained observers. We excluded patients with hysterectomy or oophorectomy or continuous use of hormonal contraceptives in the last 3 months or previous cosmetic treatments. Non-parametric tests were calculated using SPSS v 21. 0 with a p&amp;lt;0. 05. Results are expressed in medians and interquartile ranges (IQR) or percentages. Results 27 women had full workup, their median age was 32 years (IQR 25-40), the age of diagnostic of T1D was 13.5 years (IQR 10-20), 55.5% had a BMI &amp;gt;25 kg/m2, HbA1c was 8.6% (IQR 7.3-10) and used 0.83 UI insulin/kg/day (IQR 0.62-1. 06). Using the Rotterdam criteria 40.7% had PCOS, and 33.3% by stricter criteria based in hyperandrogenemia (AE-PCOS and NIH). A Ferriman-Gallwey score of 9 or higher was agreed in 40.7% of the cases with a inter-observer kappa of 77% (p&amp;lt;0. 001), 22.8% had elevated total testosterone, and 14.8% had DHEA-S above the upper limit of normal for age, the 55.6% had ultrasonographic criteria for PCOM. We eliminated 4 cases with 17-OHP progesterone of &amp;gt; 2. 0ng/mL, and 1 with undiagnosed primary ovarian insufficiency. A sample size of 41 is needed to achieve a power of 80% in this setting. Insulin doses were higher in patients with SOP compared with other patients (1. 06IU/kg/day in patients with PCOS and 0.73IU/kg/day in patients without PCOS, p=0. 013, IC -0.59; -0. 07). Discussion and conclusions Our population shows a high frequency of hyperandrogenism, which affects the patients reproductive capabilities, but also may be related to adverse metabolic outcomes. Hyperandrogenism may be related to PCOS, but also to undiagnosed comorbidities, which require further endocrine evaluation. More awareness is needed in the diagnosis of these conditions in our population. Presentation: No date and time listed

Differential subsampling with cartesian ordering: A high spatial-temporal resolution dixon imaging sequence for assessment of dural arteriovenous fistula.

To evaluate the accuracy of differential subsampling with cartesian ordering (DISCO) in comparison to time of flight (TOF) in detecting dural arteriovenous fistulas (DAVF), cerebral venous thrombosis (CVT) and hemodynamics. Sixty-two cases (24 female; aged 14-75; mean age, 51.3 years) were included in our study, with 42 positive and 20 negative cases via Digital Subtraction Angiography (DSA). Two neuroradiologists independently evaluated the DISCO and TOF. The sensitivity, specificity, and accuracy of the DISCO and TOF-MRA were individually calculated using DSA as the gold standard. Inter-observer reliability was assessed by using a weighted Cohen's kappa (κ) test; P < 0.05 was set as the threshold for statistical significance. Diagnostic sensitivities of DISCO and TOF for DAVF were 92.86 and 64.29%; specificities were 95.0% and 95.0%; while accuracies were 93.55 and 74.19% respectively. For detected CVT, sensitivities of DISCO and TOF were 100 and 92.31%; specificities were 96.55 and 93.10%; with accuracies 97.62 and 92.86% respectively. In hemodynamic analysis, sensitivity of DISCO for reflux was 95.45%; with a specificity of 95.0%; and accuracy 95.24%. The inter-observer kappa values were 0.857 for DISCO (P < 0.001). DISCO showed a high degree of sensitivity and specificity, suggesting its effectiveness in detecting DAVF with or without CVT. Intracranial hemodynamics can be identified using DISCO in DAVF patients, providing accurate evaluation of cerebral blood flow dynamics during the pre-treatment phase.

Reliability of the thoracolumbar injury classification and severity score compared with the McAfee classification among young neurosurgeons

Objective: The reliability of the thoracolumbar injury classification and severity (TLICS) score is well established; however, its reliability among young neurosurgeons in particular has not been investigated. This study was designed to identify intra- and inter-observer differences between the TLICS system and the McAfee classification among young neurosurgeons, with the goal of facilitating communication between physicians and treatment decision-making for patients with thoracolumbar injuries.Methods: Six young neurosurgeons reviewed thoracolumbar spinal fracture patients between January 2016 and October 2020 and analyzed thoracolumbar fractures according to the 2 classification systems. The intra- and inter-observer reliability of the TLICS and the McAfee scale was assessed with the Cohen and Fleiss kappa tests.Results: The intra-observer kappa value for the TLICS exhibited excellent reliability (κ=0.85) compared to the McAfee classification (κ=0.79). The inter-observer kappa values for each category of the TLICS were 0.69 (morphology), 0.93 (neurologic status), 0.74 (posterior ligamentous complex), and 0.72 (total score). The kappa value of the McAfee classification was lower (κ=0.52).Conclusion: The TLICS system showed higher reliability than the McAfee classification. The TLICS score showed more consistent results for thoracolumbar spinal fractures and may thus serve as a guideline for young neurosurgeons in treating patients with thoracolumbar fractures.