TY - JOUR
T1 - The Influence of Regional Differences on the Reliability of the AO Spine Sacral Injury Classification System
AU - Karamian, Brian A
AU - Schroeder, Gregory D
AU - Lambrechts, Mark J
AU - Canseco, Jose A
AU - Vialle, Emiliano N
AU - Rajasekaran, Shanmuganathan
AU - Benneker, Lorin M
AU - Dvorak, Marcel R
AU - Kandziora, Frank
AU - Oner, Cumhur
AU - Schnake, Klaus
AU - Kepler, Christopher K
AU - Vaccaro, Alexander R
N1 - Funding Information:
The manuscript submitted does not contain information about medical device(s)/drug(s). This study was organized and funded by AO Spine through the AO Spine Knowledge Forum Trauma, a focused group of international Trauma experts. Relevant financial activities outside the submitted work: consultancy, grants, royalties, stocks, payment for lecture. AO Spine Sacral Classification Group members: Aaron Hilis, Alfredo Guiroy, Aaron Hockley, Ahmed ShawkyAbdelgawaad, Akbar Jaleel Zubairi, Alarcon Olger, Alberto Campione, Alecio Barcelos, Alex del Arco, Alexander Weening, Ali Haghnegahdar, Ali Öner, Alqatub Ahmed, Alsammak Wael, Alvin Pun, Amit Bhandutia, Andjel German, Antonio Sanchez Rodriguez Ashraf El Naga, Barbeiro Gonçalves, Bas Teresa, Bernhard Ullrich, Bernucci Claudio, Bruno Saciloto, Carlos Pernal, Charalampidis Anastasios Christina Cheng, Ciccioli Nicolas, Cumhur Kilicer, Daniel Cruz, Daniela Linhares, Dare Ashaolu, Das Gurudip, Dave Anthony Dizon, De Falco Giovanni, Dewan Shamsul Asif, Dihan Aponso, Dimitros Patronis, Luis Miguel, Duchén Rodríguez, Elias Enmanuel, Javier Martinez, Enrico Pola, Erol Gercek, Fabii Pozzi, Frank Lyons, Geoffrey Tipper, Glukhov Dmitrii, Gupta Anuj, Hai Nie, Hamouda Waeel, Hany Soliman, Heiller Torres Valencia Huiren Tao, Ichiro Okano, Ignacio Fernández Bances Igor Paredes, Janardhana Aithala Parampalli, Jason Pittman, Javier Lecaros, Javier Matta, Jeronimo Milano, Joana Freitas, Joana Ganau, Joep Kitzen, Jorge Alves, Jose Joefrey Arbatin, Juan Carlos Ramos Torres Juan Esteban Muñoz Montoya, Juan Lourido, Jun Zhang, Khatri Manoj, Khattab Mohamed Kimmatkar Nitin, Konstantinos Margetis Kumar Vineet, Lady Lozano C, Leandro Badalassi, Lykourgos Kollintzas Maarten de Boer, Manabu Ito, Martin Estefan, Martin Holas, Martinelli Federico, Matias Pereira Duarte, Matti Scholz, Maximo-Alberto Diez-Ulloa Medina Matías, Michel Triffaux, Mohammad El-Sharkawi Morakis Andreas, Mostafa Abdelhafez, Muthu Sathish, Nasser Khan, Nicassio Nicola, Nishanth Ampar, Nuno Neves, Olga Morillo, Osmar Moraes, Osundina Ahmad, Paul van Urk, Pedro Bazán, Pershin Andrey, Peter Ferlic, Peter Loughenbury, , Philippe Bancel, Popescu Eugen Cezar Pragnesh Bhatt, Prakash Sitoula, Przemyslaw Kolakowski Purnajyoti Banerjee, Rabindra Pradhan, Rajesh Bahadur Lakhey Rakesh Kumar, Ramieri Alessamdro, Reddy Karthik, Rian Vieira, Ricardo Frada, Ricardo Rodrigues-Pinto Ricky Rasschaert, Russo Fabrizio, Salah Alakkad, Samer Samy, Sbaffi Pier Filippo, Sebastián Anibal Kornfeld Sergio Zylbersztejn, Sícoli Alfredo, Siegmund Lang, Stacey Darwish, Stipe Corluka, Subbiah Jayakumar Subramaniam Macherla haribabu, Sudhir Ganesan, Taha Karimjee, Takuya Nagai, Tarek Elhewala, Tejeda Martin, Thami Benzakour, Toluse Adetunji, Tsuyoshi Okudaira, Tulio Rangel, Umit Guler, Vijay Kumar Loya Vishwajeet Singh, Yetkin Söyüncü, Zacharia Silk, Zagorac Slavisa, Zdenek Klezl.
Publisher Copyright:
© The Author(s) 2022.
PY - 2023/9
Y1 - 2023/9
N2 - STUDY DESIGN: Global cross-sectional survey.OBJECTIVE: To explore the influence of geographic region on the AO Spine Sacral Classification System.METHODS: A total of 158 AO Spine and AO Trauma members from 6 AO world regions (Africa, Asia, Europe, Latin and South America, Middle East, and North America) participated in a live webinar to assess the reliability, reproducibility, and accuracy of classifying sacral fractures using the AO Spine Sacral Classification System. This evaluation was performed with 26 cases presented in randomized order on 2 occasions 3 weeks apart.RESULTS: A total of 8320 case assessments were performed. All regions demonstrated excellent intraobserver reproducibility for fracture morphology. Respondents from Europe (k = .80) and North America (k = .86) achieved excellent reproducibility for fracture subtype while respondents from all other regions displayed substantial reproducibility. All regions demonstrated at minimum substantial interobserver reliability for fracture morphology and subtype. Each region demonstrated >90% accuracy in classifying fracture morphology and >80% accuracy in fracture subtype compared to the gold standard. Type C morphology (p2 = .0000) and A3 (p1 = .0280), B2 (p1 = .0015), C0 (p1 = .0085), and C2 (p1 =.0016, p2 =.0000) subtypes showed significant regional disparity in classification accuracy (p1 = Assessment 1, p2 = Assessment 2). Respondents from Asia (except in A3) and the combined group of North, Latin, and South America had accuracy percentages below the combined mean, whereas respondents from Europe consistently scored above the mean.CONCLUSIONS: In a global validation study of the AO Spine Sacral Classification System, substantial reliability of both fracture morphology and subtype classification was found across all geographic regions.
AB - STUDY DESIGN: Global cross-sectional survey.OBJECTIVE: To explore the influence of geographic region on the AO Spine Sacral Classification System.METHODS: A total of 158 AO Spine and AO Trauma members from 6 AO world regions (Africa, Asia, Europe, Latin and South America, Middle East, and North America) participated in a live webinar to assess the reliability, reproducibility, and accuracy of classifying sacral fractures using the AO Spine Sacral Classification System. This evaluation was performed with 26 cases presented in randomized order on 2 occasions 3 weeks apart.RESULTS: A total of 8320 case assessments were performed. All regions demonstrated excellent intraobserver reproducibility for fracture morphology. Respondents from Europe (k = .80) and North America (k = .86) achieved excellent reproducibility for fracture subtype while respondents from all other regions displayed substantial reproducibility. All regions demonstrated at minimum substantial interobserver reliability for fracture morphology and subtype. Each region demonstrated >90% accuracy in classifying fracture morphology and >80% accuracy in fracture subtype compared to the gold standard. Type C morphology (p2 = .0000) and A3 (p1 = .0280), B2 (p1 = .0015), C0 (p1 = .0085), and C2 (p1 =.0016, p2 =.0000) subtypes showed significant regional disparity in classification accuracy (p1 = Assessment 1, p2 = Assessment 2). Respondents from Asia (except in A3) and the combined group of North, Latin, and South America had accuracy percentages below the combined mean, whereas respondents from Europe consistently scored above the mean.CONCLUSIONS: In a global validation study of the AO Spine Sacral Classification System, substantial reliability of both fracture morphology and subtype classification was found across all geographic regions.
KW - AO spine
KW - AO Trauma
KW - classification
KW - geographic region
KW - injury morphology
KW - injury subtype
KW - international
KW - intraobserver agreement
KW - reliability
KW - sacrum
UR - http://www.scopus.com/inward/record.url?scp=85122838027&partnerID=8YFLogxK
U2 - 10.1177/21925682211068419
DO - 10.1177/21925682211068419
M3 - Article
C2 - 35000410
SN - 2192-5682
VL - 13
SP - 2025
EP - 2032
JO - Global Spine Journal
JF - Global Spine Journal
IS - 7
ER -