A Concept for the Validation of Fracture Classifications

Audigé, Laurent; Bhandari, Mohit; Hanson, Beate; Kellam, James F

doi:10.1097/01.bot.0000155310.04886.37

Cited by 138 publications

(164 citation statements)

References 30 publications

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“…Evidence-based approach vs. ''eminence-based'' decisions All stages and steps of this study followed a well-defined methodological pathway [8]. This classification system is based on the first phase of a concept with sound statistical validation process including three clearly defined consecutive phases as described previously.…”

Section: Discussionmentioning

confidence: 99%

“…This revision process conformed to the guidelines of the first of three validation phases as outlined by Audigé et al [8]. The first validation phase consists of an iterative consensus development and scientific evaluation process.…”

Section: Methodsmentioning

confidence: 97%

“…The AO Spine Classification Group (AOSCG) was established with the aim to propose a uniform spine injury classification system, using the current Magerl AO system as a starting point, with the goal of addressing traumatic spinal injuries of the entire spinal column in a manner that would be useful for clinical practice and research [7,8]. This paper presents the first validation phase of the proposed classification system for thoracolumbar (TL) spinal injuries, as a revision of the original Magerl AO classification system.…”

Section: Introductionmentioning

confidence: 99%

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AO spine injury classification system: a revision proposal for the thoracic and lumbar spine

et al. 2013

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Purpose The AO Spine Classification Group was established to propose a revised AO spine injury classification system. This paper provides details on the rationale, methodology, and results of the initial stage of the revision process for injuries of the thoracic and lumbar (TL) spine. Methods In a structured, iterative process involving five experienced spine trauma surgeons from various parts of the world, consecutive cases with TL injuries were classified independently by members of the classification group, and analyzed for classification reliability using the Kappa coefficient (j) and for accuracy using latent class analysis. The reasons for disagreements were examined systematically during review meetings. In four successive sessions, the system was revised until consensus and sufficient reproducibility were achieved. Results The TL spine injury system is based on three main injury categories adapted from the original Magerl AO concept: A (compression), B (tension band), and C (displacement) type injuries. Type-A injuries include four subtypes (wedge-impaction/split-pincer/incomplete burst/ complete burst); B-type injuries are divided between purely osseous and osseo-ligamentous disruptions; and C-type injuries are further categorized into three subtypes (hyperextension/translation/separation). There is no subgroup division. The reliability of injury types (A, B, C) was good (j = 0.77). The surgeons' pairwise Kappa ranged from 0.69 to 0.90. Kappa coefficients j for reliability of injury subtypes ranged from 0.26 to 0.78. Conclusions The proposed TL spine injury system is based on clinically relevant parameters. Final evaluation data showed reasonable reliability and accuracy. Further validation of the proposed revised AO Classification requires follow-up evaluation sessions and documentation by more surgeons from different countries and backgrounds and is subject to modification based on clinical parameters during subsequent phases.

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Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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AO spine injury classification system: a revision proposal for the thoracic and lumbar spine

et al. 2013

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“…In accordance with the recommendation made by Audigé et al [3], the evaluation of this classification system was made by two orthopedic surgeons with special interest in hand surgery as well as one general orthopedic surgeon. The 1-year interval between the first and second evaluation of radiographs minimized bias due to remembering some of these.…”

Section: Discussionmentioning

confidence: 99%

The Buttazzoni Classification of Distal Radial Fractures in Adults: Interobserver and Intraobserver Reliability

Wadsten

Sayed-Noor

Sjödén

et al. 2009

Hand (New York, N,Y.)

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Despite the fact that distal radial fracture is the commonest fracture, there is a little evidence-based knowledge about the value of its classification to guide management and predict prognosis. The available classification systems are either complicated or weakly applicable in clinical practice. Older's classification is the most reliable, but does not cover all radial fracture types. We evaluated the interobserver and intraobserver reliability of a new classification system which is a modification of Older's classification covering all radial fracture types. Two hundred and thirty-two consecutive adult patients with acute distal radial fractures were blindly evaluated according to the new classification by three orthopedic surgeons twice with 1-year interval. The interobserver reliability was measured using the Fleiss kappa coefficient, and the intraobserver reliability was measured using the Cohen's kappa coefficient. The new classification showed fair to substantial interobserver and intraobserver reliability, i.e., results comparable to the reliability of commonly used classification systems. The reliability was better for younger patients and when evaluation was carried out by handsurgery-interested orthopedic surgeons. The new classification system is simple, covers all radial fracture types, and has an acceptable reliability. Further studies are needed to judge its ability to direct management and predict prognosis.

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“…In addition, classification systems play a key role in the reporting of clinical and epidemiologic data, allowing uniform comparison and documentation of such conditions. An optimal classification system should be reliable and valid, while an unreliable classification may result in unnecessary harm to patients (1). As a result, evaluation of intra-observer and inter-observer reliability of classification systems is of critical importance.…”

Section: Introductionmentioning

confidence: 99%

Inter and Intra-Observer Reliability of Dorr Classification in Proximal Femur Morphology

et al. 2018

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Background: Proximal femur morphology determines the choice of cemented or uncemented Total Hip Arthroplasty (THR), and Dorr classification is widely used to type this characteristic. As a result, a considerable reliability for such typing system is expected. Objectives: The current study aimed at assessing inter and intra-observer reliability of Dorr classification in proximal femur morphology. Methods: A total of 50 standard hip radiographs from patients with trauma or THR candidates were evaluated by 6 observers, including 2 senior orthopedic residents, 2 orthopedic surgeons, and 2 hip fellowship-trained orthopedic surgeons, using the Dorr classification system. Subsequently, radiographs were re-numbered and re-evaluated, 6 weeks after the first review. Cohen's Kappa statistic was used for statistical analysis of inter and intra-observer reliability. Results: The mean intra-observer and inter-observer kappa value for the residents was 0.560 and 0.592, respectively. The mean intra-observer and inter-observer kappa value for the orthopedists was 0.566 and 0.540, respectively. The mean intra-observer and inter-observer kappa value for the hip fellowships was 0.477 and 0.490, respectively. Conclusions: A minimum to moderate inter and intra-observer reliability of Dorr classification system was seen between the observers of the current study. These results suggest that the classification of the femur morphology is more challenging than previously described and characterization of a single Dorr type, especially in case of uncertainty between type B and C of Dorr might need reconsideration, in order to prevent its adverse effect on the patients' outcome.

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A Concept for the Validation of Fracture Classifications

Cited by 138 publications

References 30 publications

AO spine injury classification system: a revision proposal for the thoracic and lumbar spine

AO spine injury classification system: a revision proposal for the thoracic and lumbar spine

The Buttazzoni Classification of Distal Radial Fractures in Adults: Interobserver and Intraobserver Reliability

Inter and Intra-Observer Reliability of Dorr Classification in Proximal Femur Morphology

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