Inter/Intra-Observer Evaluation Between Radiographs and Tomographies for Proximal Humerus Fracture

Abstract

Objective: The use of images in 3D reconstruction is an instrument that facilitates the interpretation of the fracture, observations of deviations, rotations and articular surface. Objective: To evaluate the inter-observer and intra-observer reliability of the Neer x AO proximal humerus fracture classification on radiographs versus computed tomography with three-dimensional reconstruction (3D). Methods: We evaluated the digital radiographs (anteroposterior and profile) and computerized tomography with 3D reconstruction of patients presenting with a proximal humerus fracture, surgically treated at an Orthopedics and Traumatology Service. All radiographs and computed tomography were classified (Neer and AO) by eight (8) orthopedic surgeons, specialists in the upper limb and sent, following the pre-established numeration by the author, in a spreadsheet to the author of the study. Results: The Neer and AO scores were more reproducible when determined by computed tomography with 3D reconstruction, mainly in fractures of greater complexity (Neer 4 parts and AO group C). However, in absolute values, inter and intra-observer reproducibility and concordance still remain low. Conclusion: Computed tomography with 3D reconstruction allows a better analysis of fractures of group C and Neer 4 parts. However, the inter and intra-observer agreement does not increase significantly in comparison to the radiographs. Level of evidence III, Study of non-consecutive patients, without gold standard, applied uniformly.

Computed Tomography Does Not Improve Intra- and Interobserver Agreement of Hertel Radiographic Prognostic Criteria

“…Finally, the objective was to evaluate the role of both two- and three-dimensional CT in the interpretation of the three criteria described by Hertel, using the radiographic evaluation of the same cases as a standard. Unlike other studies [ 25 , 35 , 36 , 37 , 38 ], our study did not seek to assess whether there was a difference between 2D and 3D tomography. In the current study, we showed some usefulness for both the 2D and 3D tomography to help surgeons in the primary interpretation of Hertel prognostic criteria, with moderate intraobserver agreement, without, however, statistical difference when compared to the radiographic examination.…”

Concordância interobservadores em um checklist de cuidados em terapia nutricional enteral

“…(2) O método de concordância interobservadores foi aplicado em alguns estudos que utilizaram a avaliação clínica dos sujeitos (3,4) ou a análise por imagens de exames diagnósticos, sejam eles, ultrassonografia, ressonância magnética (RM), tomografia computadorizada (TC) e/ou radiografia (RX), na identificação de nódulos, massas, tumores e fraturas, com diferença de grau de experiência dos avaliadores. (5)(6)(7)(8) Ainda considerando-se a concordância por meio de imagens, há também alguns estudos que utilizam recursos visuais tanto ao olho nu quanto telescopicamente na avaliação do grau de lesões por pressão ou para quantificar a evolução da decomposição de cadáveres. (9,10) Corroborando com a importância da aplicação destes estudos em diferentes áreas, um estudo afirma que a avaliação interobservadores foi fundamental para garantir a qualidade do processo, assim como a prática deve ser rotina em estudos para a devida transparência na condução da pesquisa.…”

Inter-rater agreement on proximal humerus fracture treatment in Korea

“…A standardized classification system is needed for several purposes including communication between medical professionals, standardization of research, and, most importantly, for use in prognostication and to guide management and intervention. However, inter-rater agreement for classification and treatment selection of proximal humerus fractures is quite low, and decision making for the treatment of these fractures is challenging even for experienced surgeons [ 3 , 4 ]. To overcome these difficulties, several approaches, such as use of multiple Neer classifications, AO/OTA (Orthopaedic Trauma Association) [ 5 ], three-dimensional computed tomography (3D CT) [ 6 ], 3D handheld modeling [ 4 , 7 ], and artificial intelligence [ 8 ] have been reported.…”