INTEROBSERVER AGREEMENT IN THE CLASSIFICATION OF OPEN FRACTURES OF THE TIBIA - THE RESULTS OF A SURVEY OF 245 ORTHOPEDIC SURGEONS
INTEROBSERVER AGREEMENT IN THE CLASSIFICATION OF OPEN FRACTURES OF THE TIBIA - THE RESULTS OF A SURVEY OF 245 ORTHOPEDIC SURGEONS
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DOI：
10.2106/00004623-199408000-00006
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发表时间：
1994-08-01
影响因子：
5.3
通讯作者：
JONES, AL
中科院分区：
文献类型：
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作者：
BRUMBACK, RJ;JONES, AL
用于开放性骨折分类的Gustilo和Anderson系统通常被用作治疗决策和比较已发表的治疗结果的基础。通过对245名骨科医生的问卷调查，验证了该分类系统的可靠性。受访者被要求提供有关他们的年龄、实践类型和培训类型的数据；他们每年治疗的开放性胫骨骨折的数量；以及他们对古斯蒂洛-安德森分类系统的使用。他们还被要求根据一系列的病例录像对12例胫骨开放性骨折进行分类。彩色录像带上的每个病例介绍包括患者的人口统计资料、损伤史、体格检查结果、手术前开放性伤口的外观和尺寸、术前x片和手术清创术的选择部分，并配有旁白。根据选择单一分类类型的观察者的最大百分比来确定每种骨折分类的一致程度。观察人员对所有12例骨折的平均一致度为60%。每次骨折的总体一致度从42%到94%不等。在被认为经验最少的外科医生亚组（住院医生和实习医生）中，平均一致度为59%（范围为33%到94%）。在被认为最有经验的亚组（受过创伤研究培训，每年治疗12例以上胫骨开放性骨折的学术骨科医生）中，平均同意率为66%（范围为39%至100%）。我们的结论是，对于使用Gustilo-Anderson分类系统治疗开放性骨折，观察者之间的一致性是中等到较差的，一致性取决于病例，该分类系统可能不是治疗决策或比较已发表结果的充分基础。
The system of Gustilo and Anderson for the classification of open fractures is commonly used as a basis for treatment decisions and for comparison of the published results of treatment. The reliability of this classification system was tested on the basis of the responses of 245 orthopaedic surgeons to a survey. The respondents were asked to provide data about their age, type of practice, and type of training; the number of open fractures of the tibia that they treated each year; and their use of the Gustilo-Anderson classification system. They were also asked to classify twelve open fractures of the tibia on the basis of a series of videotaped case presentations. Each case presentation on the color videotape included demographic data on the patient, a history of the injury, the results of the physical examination, the appearance and dimensions of the open wound before the operation, preoperative radiographs, and selected portions of the operative debridement with narration.The level of agreement for the classification of each fracture was determined according to the largest percentage of observers who chose a single classification type. The average agreement among the observers for all twelve fractures was 60 per cent. The over-all agreement for each fracture ranged from 42 to 94 per cent. The average agreement in the subgroup of surgeons who were considered to have the least experience (residents and fellows) was 59 per cent (range, 33 to 94 per cent). The average agreement in the subgroup deemed to have the most experience (trauma-fellowship-trained, academic orthopaedic surgeons who treat more than twelve open tibial fractures each year) was 66 per cent (range, 39 to 100 per cent).We concluded that interobserver agreement with use of the Gustilo-Anderson classification system for open fractures is moderate to poor, that the agreement is case dependent, and that this classification system may not be an adequate basis for treatment decisions or for the comparison of published results.