Interobserver variation in the AO/OTA fracture classification system for Pilon fractures: Is there a problem?
Interobserver variation in the AO/OTA fracture classification system for Pilon fractures: Is there a problem?
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DOI：
10.1097/00005131-199710000-00002
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发表时间：
1997-10-01
影响因子：
2.3
通讯作者：
Kreder, HJ
中科院分区：
文献类型：
--
作者：
Swiontkowski, MF;Sands, AK;Kreder, HJ
目的：为了评估AO/OTA骨折分类系统的观察者间的变化：区域43 pilon fractions.Methods：一名高级主治医师，两名研究员（一名创伤，一名足部和踝关节），一名初级骨科住院医师和一名经验丰富的研究协调员独立分类84组X线片。评价者对治疗和功能结局不知情。对最初用于管理患者的X线片进行了评价;未使用特殊X线片或标准化X线技术。结果：使用SAV统计量来量化评分者的一致性超出预期的机会单独，平均机会调整后的协议之间的骨折类型，0.43组，0.41亚组的kappa统计，威廉姆斯指数，和SAV statistics.Results。这相当于中度一致性（0.41至0.60）。使用kappa统计量确定评定者选择骨折类型（A、B、C）时AO类型分类的任何特定类别是否存在困难。Kappa值分别为0.49为A型，0.58为B型，0.57为C型，所有这些都被认为是适当的。结论：这些数据是类似于其他报告的观察者之间的协议与AO/OTA骨折分类和其他分类系统。这些数据突出了在采取连续变量（裂缝模式）并将其划分为二分变量（裂缝分类系统）时的个人判断问题。对于骨折严重程度应作为变量报告的临床研究，单独确定骨折类型（A、B或C型）似乎就足够了。
Objectives: To evaluate the interobserver variation for the AO/OTA fracture classification system: region forty-three-pilon fractures.Methods: One senior attending, two fellows (one trauma, one foot and ankle), one junior orthopaedic resident, and one experienced research coordinator independently classified eighty-four sets of radiographs. The evaluator was blinded as to treatment and functional outcome. The radiographs initially used to manage the patients were evaluated; no special radiographs or standardized radiographic techniques were used. The kappa statistic, Williams index, and SAV statistic were calculated.Results: Using the SAV statistic to quantify rater agreement beyond that expected by chance alone, the average chance-adjusted agreement among the raters was 0.57 for fracture type, 0.43 for group, and 0.41 for subgroup. This is equivalent to moderate agreement (0.41 to 0.60). The kappa statistic was used to deter mine whether there was difficulty with any specific category of the AO type classification among raters for selecting fracture type (A, B, C). Kappa values were 0.49 for type A, 0.58 for type B, 0.57 for type C, all of which were considered adequate.Conclusion: These data are similar to others reported for interobserver agreement with the AO/OTA fracture classification and other classification systems. The issue of individual judgment in taking a continuous variable (fracture pattern) and compartmentalizing it into a dichotomous variable (fracture classification system) is highlighted by these data. Determination of fracture types alone (type A, B, or C) would seem to be sufficient for clinical research where fracture severity should be reported as a variable.