The Influence of Regional Differences on the Reliability of the AO Spine Sacral Injury Classification System

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.

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A Cross-sectional Survey of the North American Skull Base Society: Current Practice Patterns of Vestibular Schwannoma Evaluation and Management in North America

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0037-1607319 ◽

2017 ◽

Vol 79 (03) ◽

pp. 289-296 ◽

Cited By ~ 5

Author(s):

Jamie Van Gompel ◽

R. Wiet ◽

Nicole Tombers ◽

Anand Devaiah ◽

Devyani Lal ◽

...

Keyword(s):

North America ◽

Skull Base ◽

Vestibular Schwannoma ◽

North American ◽

Management Practices ◽

Current Practice ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Number Of Patients ◽

Wide Range

Background Very few studies have examined vestibular schwannoma (VS) management trends across centers and between providers. The objective of this study is to examine current practice trends, variance in treatment philosophies, and nuanced or controversial aspects of VS care across North America. Methods This is a cross-sectional survey of North American Skull Base Society (NASBS) members who report regular involvement in VS care. Results A total of 57 completed surveys were returned. Most respondents claimed to have over 20 years of experience and the majority reported working in an academic practice with an affiliated otolaryngology and/or neurosurgery residency program. Sixty-three percent of respondents claimed to evaluate VS patients in clinic with both an otolaryngologist and neurosurgeon involved. Eighty-six percent of respondents claimed to operate on VS with both an otolaryngologist and neurosurgeon involved, while only 18% of neurosurgeons and 9% of otolaryngologists performed surgery alone. There was a wide range in the number of cases evaluated at each center annually. Similarly, there was wide variation in the number of patients treated with microsurgery and radiation at each center. Additional details regarding management preferences for microsurgery, stereotactic radiosurgery, stereotactic radiotherapy, and conservative observation are presented. Conclusion VS management practices vary between providers and centers. Overall, most centers employ a multidisciplinary approach to management with collaboration between otolaryngology and neurosurgery. Overall, survey responses concur with previous studies suggesting a shift toward conservatism in management.

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The Comprehensive AO CMF Classification System for Mandibular Fractures: A Multicenter Validation Study

Craniomaxillofacial Trauma & Reconstruction ◽

10.1055/s-0038-1677459 ◽

2019 ◽

Vol 12 (4) ◽

pp. 254-265 ◽

Cited By ~ 1

Author(s):

Paul A. Mittermiller ◽

Serena S. Bidwell ◽

Florian M. Thieringer ◽

Carl-Peter Cornelius ◽

Amber W. Trickey ◽

...

Keyword(s):

Classification System ◽

Interobserver Reliability ◽

Fracture Morphology ◽

Mandibular Fractures ◽

Condylar Process ◽

Accuracy Study ◽

Level 3 ◽

Comprehensive Classification ◽

Level 2 ◽

Condylar Neck

The AO CMF has recently launched the first comprehensive classification system for craniomaxillofacial (CMF) fractures. The AO CMF classification system uses a hierarchical framework with three levels of growing complexity (levels 1, 2, and 3). Level 1 of the system identifies the presence of fractures in four anatomic areas (mandible, midface, skull base, and cranial vault). Level 2 variables describe the location of the fractures within those defined areas. Level 3 variables describe details of fracture morphology such as fragmentation, displacement, and dislocation. This multiplanar radiographic image-based AO CMF trauma classification system is constantly evolving and beginning to enter worldwide application. A validation of the system is mandatory prior to a reliable communication and data processing in clinical and research environments. This interobserver reliability and accuracy study is aiming to validate the three current modules of the AO CMF classification system for mandible trauma in adults. To assess the performance of the system at the different precision levels, it focuses on the fracture location within the mandibular regions and condylar process subregions as core components giving only secondary attention to morphologic variables. A total of 15 subjects individually assigned the location and features of mandibular fractures in 200 CT scans using the AO CMF classification system. The results of these ratings were then statistically evaluated for interobserver reliability by Fleiss’ kappa and accuracy by percentage agreement with an experienced reference assessor. The scores were used to determine if the variables of levels 2 and 3 were appropriate tools for valid classification. Interobserver reliability and accuracy were compared by hierarchy of variables (level 2 vs. level 3), by anatomical region and subregion, and by assessor experience level using Kruskal-Wallis and Wilcoxon's rank-sum tests. The AO CMF classification system was determined to be reliable and accurate for classifying mandibular fractures for most levels 2 and 3 variables. Level 2 variables had significantly higher interobserver reliability than level 3 variables (median kappa: 0.69 vs. 0.59, p < 0.001) as well as higher accuracy (median agreement: 94 vs. 91%, p < 0.001). Accuracy was adequate for most variables, but lower reliability was observed for condylar head fractures, fragmentation of condylar neck fractures, displacement types and direction of the condylar process overall, as well as the condylar neck and base fractures. Assessors with more clinical experience demonstrated higher reliability (median kappa high experience 0.66 vs. medium 0.59 vs. low 0.48, p < 0.001). Assessors with experience using the classification software also had higher reliability than their less experienced counterparts (median kappa: 0.76 vs. 0.57, p < 0.001). At present, the AO CMF classification system for mandibular fractures is suited for both clinical and research settings for level 2 variables. Accuracy and reliability decrease for level 3 variables specifically concerning fractures and displacement of condylar process fractures. This will require further investigation into why these fractures were characterized unreliably, which would guide modifications of the system and future instructions for its usage.

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Reliability and application of the new morphological classification system for chronic symptomatic osteoporotic thoracolumbar fracture

10.21203/rs.3.rs-21465/v1 ◽

2020 ◽

Author(s):

Ding-Jun Hao ◽

Jun-Song Yang ◽

Yuan Tuo ◽

Chao-Yuan Ge ◽

Bao-Rong He ◽

...

Keyword(s):

Classification System ◽

Dynamic Instability ◽

Interobserver Reliability ◽

Fracture Morphology ◽

Thoracolumbar Fracture ◽

Initial Assessment ◽

Imaging Data ◽

New Classification ◽

Wide Clinical Application ◽

Standard Classification

Abstract ObjectiveThis study proposed a new classification system for Chronic Symptomatic Osteoporotic Thoracolumbar Fracture (CSOTF) based on fracture morphology. Research on CSOTF has increased in recent years. However, the lack of a standard classification system has resulted in inconveniences regarding communication, research and treatment. Previous studies of CSOTF classification exhibit different defects, and none of these studies are widely accepted.MethodsWe collected 368 cases of CSOTF in our hospital from January 2010 to June 2017 and systematically analyzed the imaging data of all patients to develop a classification system. Imaging examinations included dynamic radiography, computed tomography scans and magnetic resonance imaging. Ten investigators systematically studied and fully understood the classification system grading 40 cases on two occasions, examined 1 month apart. Kappa coefficients (κ) were calculated to determine intraobserver and interobserver reliability.ResultsThe new classification system for CSOTF was divided into types I-V according to whether the CSOTF exhibited dynamic instability, spinal stenosis or kyphosis deformity. Intra- and interobserver reliability were excellent for all types (κ = 0.83 and 0.85, respectively).ConclusionsThe new classification system for CSOTF demonstrated excellent reliability in this initial assessment. The system is convenient for communication and research, but wide clinical application are needed to confirm its effectiveness and guide clinical treatment.

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The Subaxial Cervical AO Spine Injury Score

Global Spine Journal ◽

10.1177/2192568220974339 ◽

2020 ◽

pp. 219256822097433

Author(s):

Jose A. Canseco ◽

Gregory D. Schroeder ◽

Taylor M. Paziuk ◽

Brian A. Karamian ◽

Frank Kandziora ◽

...

Keyword(s):

Cervical Spine ◽

Classification System ◽

Cervical Spine Injury ◽

Spine Injury ◽

Cross Sectional Survey ◽

Injury Score ◽

Cross Sectional ◽

Severity Rating ◽

Subaxial Cervical Spine ◽

Injury Classification

Study Design: Global cross-sectional survey. Objective: To develop an injury score for the AO Spine Subaxial Cervical Spine Injury Classification System. Methods: Respondents numerically graded each variable within the classification system for severity. Based on the results, and with input from the AO Spine Trauma Knowledge Forum, the Subaxial Cervical AO Spine Injury Score was developed. Results: An A0 injury was assigned an injury score of 0, A1 a score of 1, and A2 a score of 2. Given the significant increase in severity, A3 was given a score of 4. Based on equal severity assessment, A4 and B1 were both assigned a score of 5. B2 and B3 injuries were assigned a score of 6. Unstable C-type injuries were given a score of 7. Stable F1 injuries were assigned a score of 2, with a 2-point increase for F2 injuries. Likewise, F3 injuries received a score of 5, whereas more unstable F4 injuries a score of 7. Neurologic status severity rating scores increased stepwise, with scores of 0 for N0, 1 for N1, and 2 for N2. Consistent with the Thoracolumbar AO Spine Injury Score, N3 (incomplete) and N4 (complete) injuries were given a score of 4. Finally, case-specific modifiers M1 (PLC injury) received a score of 1, while M2 (critical disc herniation) and M3 (spine stiffening disease) received a score of 4. Conclusions: The Subaxial Cervical AO Spine Injury Score is an easy-to-use metric that can help develop a surgical algorithm to supplement the AO Spine Subaxial Cervical Spine Injury Classification System.

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Beliefs and Determinants of Use of Traditional Complementary/Alternative Medicine in Pediatric Patients Who Undergo Treatment for Cancer in South America

Journal of Global Oncology ◽

10.1200/jgo.2016.006809 ◽

2017 ◽

Vol 3 (6) ◽

pp. 701-710 ◽

Cited By ~ 3

Author(s):

Valeria Rocha ◽

Elena J. Ladas ◽

Meiko Lin ◽

Walter Cacciavillano ◽

Elizabeth Ginn ◽

...

Keyword(s):

South America ◽

Supportive Care ◽

Alternative Medicine ◽

Wealth Index ◽

Traditional Healers ◽

Complementary Alternative Medicine ◽

Cross Sectional Survey ◽

Children With Cancer ◽

Cross Sectional ◽

American Children

Purpose The use of traditional complementary/alternative medicine (TCAM) among children with cancer has been well documented. South America has a rich history of traditional healers and medicinal resources; however, little is known about the use of TCAM among children with cancer. We sought to investigate patterns, beliefs, and determinants of TCAM use among South American children with cancer. Methods A cross-sectional survey was administered to 199 children treated for cancer at institutions located in Buenos Aires, Argentina, and Montevideo, Uruguay. Participants were queried about the type of TCAM and strength of beliefs associated with its use. Logistic regression analysis was used to estimate the odds ratios with 95% CIs. Results We found that the use of TCAM was common in both Argentina (47%) and Uruguay (76%). Variations in the forms of TCAM used were observed between the countries; however, both countries used TCAM primarily for supportive care. Mother’s education, wealth index, and TCAM belief system were significant predictors of TCAM. Conclusion To our knowledge, this study is the first to report on the use of TCAM in pediatric oncology in South America. The study identifies several predictors of TCAM use, which may serve as target variables for educational and research initiatives. The finding that most families use TCAM for supportive care suggests that future efforts could evaluate the role of TCAM to enhance existing supportive care regimens, particularly in settings where access to conventional medications are limited.

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Consensus-based classification system for intra-operative management of labral tears during hip arthroscopy—aggregate recommendations from high-volume hip preservation surgeons

Journal of Hip Preservation Surgery ◽

10.1093/jhps/hnab043 ◽

2021 ◽

Author(s):

Ajay C Lall ◽

Shawn Annin ◽

Jeff W Chen ◽

Samantha Diulus ◽

Hari K Ankem ◽

...

Keyword(s):

Decision Making ◽

Classification System ◽

High Volume ◽

Operative Management ◽

Labral Repair ◽

Cross Sectional Survey ◽

Cross Sectional ◽

System A ◽

Labral Tears ◽

Comprehensive Classification

Abstract The purpose of this study was to survey high-volume hip preservation surgeons regarding their perspectives on intra-operative management of labral tears to improve decision-making and produce an effective classification system. A cross-sectional survey of high-volume hip preservation surgeons was conducted in person and anonymously, using a questionnaire that is repeated for indications of labral debridement, repair and reconstruction given the torn labra are stable, unstable, viable or non-viable. Twenty-six high-volume arthroscopic hip surgeons participated in this survey. Provided the labrum was viable (torn tissue that is likely to heal) and stable, labral debridement would be performed by 76.92% of respondents for patients >40 years of age and by >84% of respondents for stable intra-substance labral tears in patients without dysplasia. If the labrum was viable but unstable, labral repair would be performed by >80% of respondents for patients ≤40 years of age and > 80% of respondents if the labral size was >3 mm and located anteriorly. Presence of calcified labra or the Os acetabuli mattered while deciding whether to repair a labrum. In non-viable (torn tissue that is unlikely to heal) and unstable labra, labral reconstruction would be performed by 84.62% of respondents if labral size was <3 mm. The majority of respondents would reconstruct calcified and non-viable, unstable labra that no longer maintained a suction seal. Surgeons performing arthroscopic hip labral treatment may utilize this comprehensive classification system, which takes into consideration patient age, labral characteristics (viability and stability) and bony morphology of the hip joint. When choosing between labral debridement, repair or reconstruction, consensus recommendations from high-volume hip preservation surgeons can enhance decision-making.

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A Cross-sectional Survey of the North American Skull Base Society on Vestibular Schwannoma: Part 2—Perioperative Practice Patterns of Vestibular Schwannoma in North America

Journal of Neurological Surgery Part B Skull Base ◽

10.1055/s-0038-1633441 ◽

2018 ◽

Vol 79 (S 01) ◽

pp. S1-S188

Author(s):

Jamie Van Gompel ◽

Matthew Carlson ◽

Mark Wiet ◽

Anand Devaiah ◽

Jacques Morcos ◽

...

Keyword(s):

North America ◽

Skull Base ◽

Vestibular Schwannoma ◽

North American ◽

Practice Patterns ◽

Cross Sectional Survey ◽

Cross Sectional ◽

The North

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Scientific Media Dieting and Students Awareness and Expectations about the Environmental Issues of Deforestation and Species Extinction in the Middle East and North America: An Integrated cross Cultural Ecologic-Economic Analysis

10.20944/preprints201804.0267.v1 ◽

2018 ◽

Cited By ~ 1

Author(s):

Ibrahim Niankara

Keyword(s):

North America ◽

Middle East ◽

International Student ◽

Environmental Awareness ◽

Student Assessment ◽

Environmental Issues ◽

Cross Sectional Survey ◽

Species Extinction ◽

Cross Sectional ◽

International Student Assessment

This study inscribes itself in the global discussion about the issue of environmental awareness, beliefs and behaviors. Here we focus on the role that cultural differences and scientific media dieting play in explaining heterogeneities in students' awareness and expectations about the two environmental issues of deforestation and species (plant and animal) extinction in the Middle East and North America. To this end, we use the cross-sectional survey data of the OECD's Program for International Student Assessment (PISA) 2015, along with seemingly unrelated Bi-variate ordered Probit modeling techniques. The results show that compared to their North American Counterparts, students' in the Middle East are 14.2% less aware of, and 14.5% less optimistic about the issue of deforestation, while 38.9% less aware of, and 59.0% less optimistic about the issue of species extinction. In addition, we found that science club attendance and broad science reading in books are the two most effective communication media for raising students awareness about the two environmental issues. In fact, every one level increase in students' awareness is found to raise their optimism by 20.4% for the issue of deforestation, and 15.0% for the issue of plant and animal extinction. Therefore raising young people environmental awareness and optimism through proper communication strategies, could be invaluable for achieving an economic development in line with our need to preserve the natural environment and ecosystem services for generations to come.

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Good practices in the management of medical gases in teaching hospitals in Brazil: situational diagnosis

Revista Brasileira de Farmácia Hospitalar e Serviços de Saúde ◽

10.30968/rbfhss.2021.124.0685 ◽

2021 ◽

Vol 12 (4) ◽

pp. 685

Author(s):

Fábio J. AMORIM ◽

Lincoln C. SANTOS ◽

Fernando ARAÚJO-NETO ◽

Lucimara M. ANDRADE ◽

Dyego C. ARAÚJO ◽

...

Keyword(s):

Geographic Region ◽

Teaching Hospitals ◽

Healthcare Team ◽

Cross Sectional Survey ◽

Chi Square ◽

Small Hospital ◽

Cross Sectional ◽

Performance Category ◽

Good Practices

Objective: To characterize compliance with good practices in medical gas management in federal teaching hospitals in Brazil. Methods: A cross-sectional survey-type study, designed to perform a situational diagnosis of the pharmacy services in 40 federal teaching hospitals in Brazil linked to the Brazilian Hospital Services Company, with respect to compliance with good practices in gas management, through the application of the ABPGasMed 1.0 instrument. This instrument consists of 54 compliance standards divided into two sections (structure and process). The characterization of research participants and hospitals, and the classification of hospitals in terms of performance categories were expressed as absolute and relative values. Chi-square tests of independence were performed to investigate the association between the hospital’s performance category and the hospital’s geographic region and size. Results: In total, 87.5% of the invited hospitals participated in the study, and only 27.59% of the hospitals had a pharmacist responsible for medicinal gases. Pharmacovigilance was performed by pharmacists in 20.59% of the hospitals. Analyzing the hospitals by region of the country and size, statistically significant associations were found between the general classification of hospitals and the geographic region (x2(8)=18.936, p= 0.015), as well as the classification of the hospital and structure and size (x2(9)= 20.373, p= 0.016). Analyses of the adjusted standardized residues returned an association between the southeastern region and the satisfactory performance category when analyzing the entire instrument, and between the excellent performance category in the structure section and size of a small hospital. Conclusion: In most of the hospitals studied, management of medicinal gases did not show the desired performance, which indicates the need to comply with current healthcare legislations and improve the provided services. It is believed that compliance rates may evolve training of healthcare team members, with an emphasis on the pharmacist.

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