The new AO classification system for intertrochanteric fractures allows better agreement than the original AO classification. An inter- and intra-observer agreement evaluation.
Agreement study
Fracture classification
Hip fracture
Trochanteric area fracture
Journal
Injury
ISSN: 1879-0267
Titre abrégé: Injury
Pays: Netherlands
ID NLM: 0226040
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
27
05
2020
accepted:
07
07
2020
pubmed:
14
7
2020
medline:
22
6
2021
entrez:
14
7
2020
Statut:
ppublish
Résumé
A new AO classification for intertrochanteric fractures was recently published; no studies have evaluated its inter- and intra-observer agreement. Six evaluators (three hip subspecialists and three residents) assessed radiographs of 68 intertrochanteric fractures; fractures were classified using the original and the new AO classifications. The cases were displayed in a random sequence after a six-week interval for repeat evaluation. We used the Kappa coefficient (k) to determine inter- and intra-observer agreement. Inter-observer agreement was slight (k = 0.128 [0.092-0.170]) using the original and fair (k = 0.250 [0.186-0.327]), with the new AO classification. Orthopedic residents exhibited better agreement than hip surgeons using the original classification (k = 0.302 [0.210-0.416] and k= -0.018 [-0.058-0.029], respectively) and the new classification (k = 0.388 [0.294-0.514] and k = 0.109 [0.031-0.192], respectively). Using both classifications as dichotomous variables (stable or unstable patterns), the agreement was slight (k = 0.158 [0.074-0.246]) using the original classification and moderate (k = 0.425 [0.308-0.550]) with the new AO classification. The agreement was fair using the original (k = 0.350 [0.278-0.424]) and the new (k = 0.295 [0.239 to 0.353]) AO classifications, respectively. Residents had better agreement than hip specialists using the original (k = 0.405 [0.303-0.512]) versus (k = 0.292 [0.193-0.293]) and the new classification (k = 0.449 [0.370 to 0.528] versus k = 0.129 [0.064 to 0.208]). The inter-observer agreement using the new AO classification was significantly better than using its original version. Also, the new AO classification system allowed better agreement when distinguishing stable from unstable patterns.
Sections du résumé
BACKGROUND
BACKGROUND
A new AO classification for intertrochanteric fractures was recently published; no studies have evaluated its inter- and intra-observer agreement.
METHODS
METHODS
Six evaluators (three hip subspecialists and three residents) assessed radiographs of 68 intertrochanteric fractures; fractures were classified using the original and the new AO classifications. The cases were displayed in a random sequence after a six-week interval for repeat evaluation. We used the Kappa coefficient (k) to determine inter- and intra-observer agreement.
RESULTS
RESULTS
Inter-observer agreement was slight (k = 0.128 [0.092-0.170]) using the original and fair (k = 0.250 [0.186-0.327]), with the new AO classification. Orthopedic residents exhibited better agreement than hip surgeons using the original classification (k = 0.302 [0.210-0.416] and k= -0.018 [-0.058-0.029], respectively) and the new classification (k = 0.388 [0.294-0.514] and k = 0.109 [0.031-0.192], respectively). Using both classifications as dichotomous variables (stable or unstable patterns), the agreement was slight (k = 0.158 [0.074-0.246]) using the original classification and moderate (k = 0.425 [0.308-0.550]) with the new AO classification.
INTRA-OBSERVER
UNASSIGNED
The agreement was fair using the original (k = 0.350 [0.278-0.424]) and the new (k = 0.295 [0.239 to 0.353]) AO classifications, respectively. Residents had better agreement than hip specialists using the original (k = 0.405 [0.303-0.512]) versus (k = 0.292 [0.193-0.293]) and the new classification (k = 0.449 [0.370 to 0.528] versus k = 0.129 [0.064 to 0.208]).
CONCLUSION
CONCLUSIONS
The inter-observer agreement using the new AO classification was significantly better than using its original version. Also, the new AO classification system allowed better agreement when distinguishing stable from unstable patterns.
Identifiants
pubmed: 32654847
pii: S0020-1383(20)30580-5
doi: 10.1016/j.injury.2020.07.020
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
102-105Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2020. Published by Elsevier Ltd.
Déclaration de conflit d'intérêts
Declaration of Competing Interests The authors of this article declare they have no Conflict of Interest to disclose