The Radiographic Union Score for Hip (RUSH): the use of a checklist to evaluate hip fracture healing improves agreement between radiologists and orthopedic surgeons
The Radiographic Union Score for Hip (RUSH): the use of a checklist to evaluate hip fracture healing improves agreement between radiologists and orthopedic surgeons
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DOI：
10.1007/s00256-013-1605-8
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发表时间：
2013-08-01
影响因子：
2.1
通讯作者：
Bhandari, Mohit
中科院分区：
文献类型：
--
作者：
Chiavaras, Mary M.;Bains, Simrit;Bhandari, Mohit
股骨粗隆间骨折固定后骨折愈合的评估变化很大，没有经过验证的标准。手术后骨折愈合的一致性对于最佳患者管理非常重要。本研究的目的是 (1) 评估股骨粗隆间骨折愈合评估的可靠性，以及 (2) 确定新型髋部骨折放射学评分系统是否可以提高放射科医生和骨科医生之间的一致性。由三名放射科医生和三名骨科医生组成的小组在两个不同的时间点评估了 150 例股骨转子间骨折的骨折愈合情况，以确定评估者间和评估者内的一致性。评审人员对受伤后的时间不知情，首先使用每位患者在单个时间点的正面和侧面X光片主观评估整体愈合情况。然后，评审者使用髋关节放射学联合评分 (RUSH) 表格对每次骨折进行评分，以确定这是否提高了髋部骨折愈合的一致性。评审者组之间骨折愈合总体主观印象的评审者间一致性只是公平的（组内系数 [ICC] = 0.34，95 % CI：0.11-0.52。RUSH 评分的使用显着提高了组之间的总体一致性（ICC = 0.66，95 % CI： 0.53-0.75）。在评价者中，内侧皮质的愈合和总体 RUSH 评分本身与总体愈合感知具有高度相关性（分别为 r = 0.53 和 r = 0.72）。RUSH 评分提高了骨科医生和放射科医生之间骨折愈合评估的一致性，提供了评估股骨粗隆间髋部骨折 X 线照片的系统方法，并可能最终提供预测患者愈合结果的预后信息。股骨颈骨折。
The assessment of fracture healing following intertrochanteric fracture fixation is highly variable with no validated standards. Agreement with respect to fracture healing following surgery is important for optimal patient management. The purpose of this study was to (1) assess reliability of intertrochanteric fracture healing assessment and (2) determine if a novel radiographic scoring system for hip fractures improves agreement between radiologists and orthopedic surgeons.A panel of three radiologists and three orthopedic surgeons assessed fracture healing in 150 cases of intertrochanteric fractures at two separate time points to determine inter-rater and intra-rater agreement. Reviewers, blinded to the time after injury, first subjectively assessed overall healing using frontal and lateral radiographs for each patient at a single time point. Reviewers then scored each fracture using a Radiographic Union Score for Hip (RUSH) form to determine whether this improves agreement regarding hip fracture healing.Inter-rater agreement for the overall subjective impression of fracture healing between reviewer groups was only fair (intraclass coefficient [ICC] = 0.34, 95 % CI: 0.11-0.52. Use of the RUSH score improved overall agreement between groups to substantial (ICC = 0.66, 95 % CI: 0.53-0.75). Across reviewers, healing of the medial cortex and overall RUSH score itself demonstrated high correlations with overall perceptions of healing (r = 0.53 and r = 0.72, respectively).The RUSH score improves agreement of fracture healing assessment between orthopedic surgeons and radiologists, offers a systematic approach to evaluating intertrochanteric hip fracture radiographs, and may ultimately provide prognostic information that could predict healing outcomes in patients with femoral neck fractures.