TY - JOUR
T1 - The influence of surgeon experience and subspeciality on the reliability of the AO spine sacral classification system
AU - Karamian, Brian A.
AU - Schroeder, Gregory D.
AU - Levy, Hanna A.
AU - Canseco, Jose A.
AU - Benneker, Lorin M.
AU - Kandziora, Frank
AU - Rajasekaran, Shanmuganathan
AU - Öner, F. Cumhur
AU - Schnake, Klaus J.
AU - Kepler, Christopher K.
AU - Vaccaro, Alexander R.
AU - Hilis, Aaron
AU - Guiroy, Alfredo
AU - Hockley, Aaron
AU - Abdelgawaad, Ahmed Shawky
AU - Zubairi, Akbar Jaleel
AU - Olger, Alarcon
AU - Campione, Alberto
AU - Barcelos, Alecio
AU - del Arco, Alex
AU - Weening, Alexander
AU - Haghnegahdar, Ali
AU - Öner, Ali
AU - Ahmed, Alqatub
AU - Wael, Alsammak
AU - Pun, Alvin
AU - Bhandutia, Amit
AU - German, Andjel
AU - Rodriguez, Antonio Sanchez
AU - Naga, Ashraf El
AU - Gonçalves, Barbeiro
AU - Teresa, Bas
AU - Ullrich, Bernhard
AU - Claudio, Bernucci
AU - Saciloto, Bruno
AU - Pernal, Carlos
AU - Anastasios, Charalampidis
AU - Cheng, Christina
AU - Nicolas, Ciccioli
AU - Kilicer, Cumhur
AU - Cruz, Daniel
AU - Linhares, Daniela
AU - Ashaolu, Dare
AU - Gurudip, Das
AU - Dizon, Dave Anthony
AU - Giovanni, De Falco
AU - Asif, Dewan Shamsul
AU - Kitzen, Joep
AU - de Boer, Maarten
AU - van Urk, Paul
N1 - Funding Information:
This study was organized and funded by AO Spine International through the AO Spine Knowledge Forum Trauma, a focused group of international spinal trauma experts acting on behalf of AO Spine. AO Spine is a clinical division of the AO Foundation which is an independent medically-guided non-profit organization. Study support was provided directly through the AO Spine Research Department. The authors would like to thank Olesja Hazenbiller (AO Spine) for her editorial and administrative assistance.
Funding Information:
This study was organized and funded by AO Spine through the AO Spine Knowledge Forum Trauma, a focused group of international Trauma experts.
Publisher Copyright:
© 2021 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2021/12/15
Y1 - 2021/12/15
N2 - Study Design. Cross-sectional survey. Objective. To determine the influence of surgeons’ level of experience and subspeciality training on the reliability, reproducibility, and accuracy of sacral fracture classification using the Arbeitsgemeinschaft für Osteosynthesefragen Spine Sacral Classification System. Summary of Background Data. A surgeons’ level of experience or subspecialty may have a significant effect on the reliability and accuracy of sacral classification given various levels of comfort with imaging assessment required for accurate diagnosis and classification. Methods. High-resolution computerized tomography (CT) images from 26 cases were assessed on two separate occasions by 172 investigators representing a diverse array of surgical subspecialities (general orthopedics, neurosurgery, orthopedic spine, orthopedic trauma) and experience (<5, 5–10, 11–20, >20yrs). Reliability and reproducibility were calculated with Cohen kappa coefficient (k) and gold standard classification agreement was determined for each fracture morphology and subtype and stratified by experience and subspeciality. Results. Respondents achieved an overall k ¼ 0.87 for morphology and k ¼ 0.77 for subtype classification, representing excellent and substantial intraobserver reproducibility, respectively. Respondents from all four practice experience groups demonstrated excellent interobserver reliability when classifying overall morphology (k ¼ 0.842/0.850, Assessment 1/Assessment 2) and substantial interobserver reliability in overall subtype (k ¼ 0.719/ 0.751) in both assessments. General orthopedists, neurosurgeons, and orthopedic spine surgeons exhibited excellent interobserver reliability in overall morphology classification and substantial interobserver reliability in overall subtype classification. Surgeons in each experience category and subspecialty correctly classified fracture morphology in over 90% of cases and fracture subtype in over 80% of cases according to the gold standard. Correct overall classification of fracture morphology (Assessment 1: P ¼ 0.024, Assessment 2: P ¼ 0.006) and subtype (P2 < 0.001) differed significantly by years of experience but not by subspecialty. Conclusion. Overall, the Arbeitsgemeinschaft für Osteosynthesefragen spine sacral classification system appears to be universally applicable among surgeons of various subspecialties and levels of experience with acceptable reliability, reproducibility, and accuracy.
AB - Study Design. Cross-sectional survey. Objective. To determine the influence of surgeons’ level of experience and subspeciality training on the reliability, reproducibility, and accuracy of sacral fracture classification using the Arbeitsgemeinschaft für Osteosynthesefragen Spine Sacral Classification System. Summary of Background Data. A surgeons’ level of experience or subspecialty may have a significant effect on the reliability and accuracy of sacral classification given various levels of comfort with imaging assessment required for accurate diagnosis and classification. Methods. High-resolution computerized tomography (CT) images from 26 cases were assessed on two separate occasions by 172 investigators representing a diverse array of surgical subspecialities (general orthopedics, neurosurgery, orthopedic spine, orthopedic trauma) and experience (<5, 5–10, 11–20, >20yrs). Reliability and reproducibility were calculated with Cohen kappa coefficient (k) and gold standard classification agreement was determined for each fracture morphology and subtype and stratified by experience and subspeciality. Results. Respondents achieved an overall k ¼ 0.87 for morphology and k ¼ 0.77 for subtype classification, representing excellent and substantial intraobserver reproducibility, respectively. Respondents from all four practice experience groups demonstrated excellent interobserver reliability when classifying overall morphology (k ¼ 0.842/0.850, Assessment 1/Assessment 2) and substantial interobserver reliability in overall subtype (k ¼ 0.719/ 0.751) in both assessments. General orthopedists, neurosurgeons, and orthopedic spine surgeons exhibited excellent interobserver reliability in overall morphology classification and substantial interobserver reliability in overall subtype classification. Surgeons in each experience category and subspecialty correctly classified fracture morphology in over 90% of cases and fracture subtype in over 80% of cases according to the gold standard. Correct overall classification of fracture morphology (Assessment 1: P ¼ 0.024, Assessment 2: P ¼ 0.006) and subtype (P2 < 0.001) differed significantly by years of experience but not by subspecialty. Conclusion. Overall, the Arbeitsgemeinschaft für Osteosynthesefragen spine sacral classification system appears to be universally applicable among surgeons of various subspecialties and levels of experience with acceptable reliability, reproducibility, and accuracy.
KW - AO spine
KW - Classification
KW - Pelvic fracture
KW - Sacral fracture
KW - Spine trauma
KW - Subspecialty
KW - Surgeon experience
KW - Validation
KW - Reproducibility of Results
KW - Cross-Sectional Studies
KW - Humans
KW - Thoracic Vertebrae
KW - Surgeons
KW - Observer Variation
UR - http://www.scopus.com/inward/record.url?scp=85120679136&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000004199
DO - 10.1097/BRS.0000000000004199
M3 - Article
C2 - 34392274
AN - SCOPUS:85120679136
SN - 0362-2436
VL - 46
SP - 1705
EP - 1713
JO - Spine
JF - Spine
IS - 24
ER -