Reliability and reproducibility analysis of the AOSpine Sacral Fractures Classification System by spinal and pelvic surgeons |
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| Affiliation: | 1. ASST Grande Ospedale Metropolitano Niguarda, U.O. Ortopedia e Traumatologia, Milano, Italy;2. Spine Surgery Division, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini – CTO, Milano, Italy;3. Klinik Chirurgie, Spital Lachen, Lachen, Switzerland;1. Department of Medical Imaging, University Hospital of Heraklion, Voutes, 71110, Crete, Greece;2. Computational BioMedicine Laboratory, Institute of Computer Science, Foundation for Research and Technology (FORTH), N. Plastira 100, 70013, Heraklion, Crete, Greece;3. Advanced Hybrid Imaging Systems, Institute of Computer Science, Foundation for Research and Technology (FORTH), N. Plastira 100, 70013, Heraklion, Crete, Greece;4. Department of Radiology, School of Medicine, University of Crete, Voutes Campus, 71003, Heraklion, Greece;5. Department of Anatomy, Medical School, University of Thessaly, Biopolis, 41500, Larissa, Greece;6. Department of Electrical & Computer Engineering, Hellenic Mediterranean University, Estavromenos, Heraklion 71410, Crete, Greece;1. Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA;2. Department of Surgery (Trauma), Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY 10461, USA;3. Department of Surgery (Ophthalmology), Jacobi Medical Center, 1400 Pelham Parkway, Bronx, NY 10461, USA;4. Department of Ophthalmology & Visual Sciences, Albert Einstein College of Medicine, Bronx, 1300 Morris Park Avenue, NY 10461, USA;1. Registrar in Trauma & Orthopaedics, Royal Free London NHS Foundation Trust. London, United Kingdom;2. Registrar in Trauma & Orthopaedics., Barking, Havering & Redbridge University Hospitals NHS Trust. London, United Kingdom;3. Consultant Orthopaedic & Trauma Surgeon. University Hospitals Birmingham NHS Foundation Trust. Birmingham, United Kingdom;4. Consultant Orthopaedic & Trauma Surgeon. Royal Free London NHS Foundation Trust. London, United Kingdom;5. Consultant Paediatric Orthopaedic & Trauma Surgeon, University Hospitals Coventry and Warwickshire NHS Trust. Coventry, United Kingdom |
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| Abstract: | Study DesignRetrospective Cohort StudyObjectivesThe AOSpine Sacral Classification System was proposed as a comprehensive and universally accepted new classification for Sacral Fractures, and was recently internally validated. However, an external, independent and multidisciplinary reports on validation of this classification is lacking. Aim of the present study is to analyze the interobserver reliability and intraobserver reproducibility of the AOSpine Sacral Classification System for Sacral Fractures between orthopedic spinal and pelvic surgeons with different levels of experience.MethodsOur institutional database was searched to retrieve patients with acute, traumatic sacral injury admitted from June 2017 to June 2020. For each patients, X-Rays and CT scans were collected. Three Orthopedic Pelvic Surgeons (Group A) and three Spine Surgeons (Group B), with different level of experience (Junior, 〈 5 years; Middle, 5–10 years; Expert 〉 10 years) independently classified all the sacral fractures included in the dataset, with two separate evaluation three weeks apart. Both intra and interobserver reliability were calculated with k-coefficient.ResultsOverall, 150 patients were included in the final dataset, for a total of 1800 different assessments, with all the subtypes reported. The intraobserver reproducibility for the whole group was substantial (κ=0.72). Overall, the interobserver reliability was moderate, with a κ=0.57. When only fracture type was taken in account, the κ value became substantial (κ=0.62). No significant differences were found comparing group A and group B (0.55 vs κ 0.55, p>0.05). No significant differences according to surgeon's experience were found; however, the κ value was slightly lower among the junior surgeons.ConclusionsOur findings confirmed the reliability and reproducibility of this classification in clinical practice. In the current study the surgeon's expertise (pelvic and spinal trauma) and the level of experience does not influence the reliability of the classification system. |
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