CLASSIFICATION OF ACL TEARS IN THE PEDIATRIC AND ADOLESCENT POPULATION

Background: There have been previous imaging classification schemes in the literature that described ACL tears in adults and pediatric patients. More recent publications have described the epidemiology, injury mechanisms, and repair versus reconstruction techniques. None have proposed an arthroscopic classification for pediatric patients. Purpose: To describe our experience with a novel arthroscopic classification using 4 patterns of ACL tears depending on the type of tear and the tissue quality. Methods: An IRB approved prospective with 2 parts to this study: Part 1: Single center prospective case series using descriptive statistics of intraoperative findings. We included children ≤18 years old with an ACL tear who underwent surgery within 8 weeks of injury. Those with associated ligamentous injuries or revision surgery were excluded. We proposed a 4-stage classification as follows: I. Avulsion off femur II. <10% tear from femoral end III. Midsubstance tear IV. Single bundle tear. Part 2: Four fellowship-trained surgeons from two tertiary children’s hospitals classified ACL injury based on intraoperative video of 33 randomly selected surgeries. 2 rounds of classification were performed. Inter and intra-observer reliability studies were calculated using Kappa statistics. Results: 120 patients (73 males and 47 females) with mean age of 16 (9-20) years and mean BMI 26 (16-51) were included in this study. 59 patients (49%) had left sided injury while 61 (51%) had right sided injury. 29 (24%) patients reported contact injury while 91 (76%) reported non-contact. Isolated ACL injury was recorded in 49 patients only (41%) while concomitant injuries were recorded in 71 patients (59%). The most common associated injury was the lateral meniscus tear (33%), followed by lateral and medial meniscus tear (13.4%). According to our classification, 23 (19.2%) patients were type I, 15 (12.5%) were type II, 65 (54.2%) were type III, and 17 (14.2%) were type IV. The intra-rater reliability was excellent for 2 reviewers, good for 1 and marginal for another. The overall inter rater reliability for all 4 reviewers was marginal for both readings (k=0.35, 95% CI: 0.23-0.44; k=0.26, 95%CI: 0.16-0.35 respectively). Conclusion: With renewed interest in ACL repairs and techniques, a classification system for ACL tears can guide a proper surgical plan. Our classification system provides a step to achieve this goal. It showed overall good intra-observer reliability, with marginal inter-observer reliability.

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Fractures of the Lateral Process of the Talus: A New Classification Based on CT

10.21203/rs.3.rs-138940/v1 ◽

2021 ◽

Author(s):

Yuchuan Wang ◽

Yanbin Zhu ◽

Xiangtian Deng ◽

Zhongzheng Wang ◽

Siyu Tian ◽

...

Keyword(s):

Classification System ◽

Intraobserver Reliability ◽

Kappa Statistics ◽

Type I ◽

New Classification ◽

Concomitant Injuries ◽

Term Outcome ◽

Long Term Outcome ◽

Lateral Process ◽

Comprehensive Classification

Abstract Background: The common classifications of the fractures of the lateral process of the talus（LTPFs）are based on radiographs and may underestimate the complexity of LTPF, therefore, requiring a comprehensive classification based on CT(Computed tomography) scan. The aim of this study is to propose a such classification system, and to evaluate its reliability and reproducibility.Methods: On the basis of the most widely recognized classifications of Hawkins as well as McCrory-Bladin, we proposed a new and comprehensive classification based on CT scan for the LTPF. We retrospectively reviewed 42 patients involving LTPF. All fractures were classified according to Hawkins, McCrory-Bladin and new proposed classification system by three surgeons. The analysis of interobserver and intraobserver agreements was done using kappa statistics.Results: This new classification included two types based on presence of concomitant injuries or not, with type I consisting of three subtypes and type II of five subtypes. Interobserver and intraobserver reliability of the new classification system were almost perfect (κ=0.846 and 0.823, respectively)，showing a higher interobserver and intraobserver reliability compared to the Hawkins classification (κ=0.737 and 0.689, respectively) as well as McCrory-Bladin classification (κ=0.748 and 0.714, respectively). Conclusion: This new classification system for the LTPF based on CT is a comprehensive classification considering concomitant injuries. It is more reliable and reproducible and can potentially become a useful instrument for decision making of treatment options for LTPFs. Further studies on the evaluation of their clinical relevance (especially the long-term outcome) are warranted.

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Independent Inter- and Intra-Rater Reliability of the New AO and Leonetti/Tigani Systems for Pilon Fractures based on CT-Scan

Foot & Ankle Orthopaedics ◽

10.1177/2473011420s00236 ◽

2020 ◽

Vol 5 (4) ◽

pp. 2473011420S0023

Author(s):

Benjamin Guiloff ◽

Andres Villa ◽

Joaquin Ananias ◽

Pablo Mery ◽

Gerardo Ledermann ◽

...

Keyword(s):

Ct Scan ◽

Classification System ◽

Rater Reliability ◽

Ao Classification ◽

Observer Reliability ◽

Tibial Plafond ◽

Significant Difference ◽

Preoperative Ct ◽

Tibial Plafond Fractures ◽

Different Levels

Category: Basic Sciences/Biologics; Trauma Introduction/Purpose: There is still no consensus regarding which is the best classification system for the management of tibial plafond fractures. The goal of this study is to perform a independent agreement evaluation to compare two recently published systems: Leonetti/Tigani and the new AO classification. Methods: Seventy-five patients with tibial plafond fracture and preoperative CT scan were included. Six raters with different level of expertise (two foot and ankle surgeons and three orthopedic surgery residents) classified the fractures using CT scans according to the morphological grading of both systems. The Leonetti/Tigani classification system considers four types (I, II, III and IV) and six subtypes (I, IIF, IIS, IIIF, IIIS, IV). The AO system considers three types (A, B, C) and nine subtypes (A1, A2, A3, B1, B2, B3, C1, C2, C3). After six weeks all cases were randomly re-evaluated by the same raters. The kappa coefficient (κ) was used to determine the degree of reliability. Results: Inter-observer reliability: strong using the Leonetti/Tigani classification system considering types, with a κ of 0,65 (0,60 - 0,69), and subtypes, with a κ of 0,62 (0,58 - 0,66). Reliability for the AO system was strong considering types with a κ of 0,72 (0,66 - 0,78), but moderate when including subtypes with a κ of 0,54 (0,50 - 0,57). Intra-rater reliability: Almost perfect using the Leonetti/Tigani classification considering both types and subtypes with a κ of 0,94 (0,88- 1,01) and 0,94 (0,89- 0,96), respectively. Reliability for the AO system was almost perfect considering types with a κ of 0,83 (0,75- 0,92), but strong when including subtypes with a κ of 0,61 (0,57- 0,66). No statistically significant difference between different levels of expertise. Conclusion: The system proposed by Leonetti/Tigani demonstrated a strong and almost perfect inter and intra-rater reliability, respectively. Although the new AO classification has a strong inter-rater reliability when including the main categories, it only reached a moderate reliability when including subtypes.

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New Classification Based on CT and Its Value Evaluation for Fractures of the Lateral Process of the Talus

10.21203/rs.3.rs-489905/v1 ◽

2021 ◽

Author(s):

Yuchuan Wang ◽

Xiangtian Deng ◽

Yanbin Zhu ◽

Zhongzheng Wang ◽

Lei Fu ◽

...

Keyword(s):

Classification System ◽

Prognostic Value ◽

Treatment Options ◽

Intraobserver Reliability ◽

Kappa Statistics ◽

Type I ◽

New Classification ◽

Concomitant Injuries ◽

Lateral Process ◽

Comprehensive Classification

Abstract Background : The common classifications of the fractures of the lateral process of the talus（LTPFs）are based on radiographs and may underestimate the complexity of LTPF, therefore. The aim of this study was to propose a comprehensive CT-based classification system, and to evaluate its prognostic value, reliability and reproducibility.Material and Methods: We retrospectively reviewed 42 patients involving LTPF and clinical and radiographic evaluations were performed at an average follow-up of 35.9 months. In order to create a comprehensive classification, a panel of experienced orthopedic surgeons discussed the cases. All fractures were classified according to Hawkins, McCrory-Bladin and new proposed classification system by four surgeons. The analysis of interobserver and intraobserver agreements was done using kappa statistics.Results: This new classification included two types based on presence of concomitant injuries or not, with type I consisting of three subtypes and type II of five subtypes. Average AOFAS score was 91.5 in the type Ia of new classification proposed, 86 in type Ib, 90.5 in type Ic, 89 in type IIa, 76.7 in type IIb, 76.6 in type IIc, 91.3 in type IId, and 83.5 in type IIe. Interobserver and intraobserver reliability of the new classification system were almost perfect (κ=0.846 and 0.823, respectively)，showing a higher interobserver and intraobserver reliability compared to the Hawkins classification (κ=0.737 and 0.689, respectively) as well as McCrory-Bladin classification (κ=0.748 and 0.714, respectively). Conclusion: The new classification system is a comprehensive one that takes into account concomitant injuries and it shows good prognostic value with clinical outcomes. It is more reliable and reproducible and could be a useful tool for decision-making on treatment options for LTPFs.

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Which factors are associated with the prevalence of meniscal repair?

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04107-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Xiaoxiao Song ◽

Dongyang Chen ◽

Xinsheng Qi ◽

Qing Jiang ◽

Caiwei Xia

Keyword(s):

Cruciate Ligament ◽

Demographic Data ◽

Meniscal Tear ◽

Univariate Analysis ◽

Lateral Meniscus ◽

Meniscal Repair ◽

Acl Injury ◽

Partial Meniscectomy ◽

Meniscus Tear ◽

Confounding Factors

Abstract Purpose To investigate the potential factors associated with the prevalence of meniscal repair Methods Patients who received partial meniscectomy or meniscal repair in our institution from Jan 2015 to Dec 2019 were included in current study. The inclusion criteria were (1) meniscus tear treated using meniscectomy or repair, (2) with or without concomitant anterior cruciate ligament reconstruction, (3) not multiligamentous injury. Demographic data, including sex, age, body mass index (BMI), injury-to-surgery interval and intra-articular factors such as the location of injury, medial or lateral, ACL rupture or not and the option of procedure (partial meniscectomy or repair) were documented from medical records. Univariate analysis consisted of chi-square. Multivariate logistic regression was then performed to adjust for confounding factors. Results 592 patients including 399 males and 193 females with a mean age of 28.7 years (range from 10 to 75 years) were included in current study. In the univariate analysis, male (p = 0.002), patients aged 40 years or younger (p < 0.001), increased weight (p = 0.010), Posterior meniscus torn (0.011), concurrent ACL ruputure (p < 0.001), lateral meniscus (p = 0.039) and early surgery (p < 0.001) were all associated with the prevalence of meniscal repair. However, After adjusting for confounding factors, we found that age (OR, 0.35; 95% CI, 0.17 - 0.68, p = 0.002), ACL injury (OR, 3.76; 95% CI, 1.97 – 7.21, p < 0.001), side of menisci (OR, 3.29; 95% CI, 1.43 – 7.55, p = 0.005), site of tear (OR, 0.15; 95% CI, 0.07 – 0.32, p < 0.001), and duration of injury (OR, 0.46; 95% CI, 0.28 – 0.82, p = 0.008) were associated with the prevalence of meniscus repair. Conclusions Meniscal tear in aged patients especially those with concomitant ACL injury is likely to be repaired. Additionally, in order to increase the prevalence of repair and slow down progression of OA, the surgical procedure should be performed within two weeks after meniscus tear especially when the tear is located at lateral meniscal posterior. Study design Case-control study; level of evidence, 3.

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Inter-observer reliability of a risk assessment model for venous thromboembolism in acutely-ill medical hospitalized patients: Results from a prospective cohort study

Phlebology The Journal of Venous Disease ◽

10.1177/02683555211021226 ◽

2021 ◽

pp. 026835552110212

Author(s):

Cassia RL Ferreira ◽

Marcos de Bastos ◽

Mirella L Diniz ◽

Renan A Mancini ◽

Yan S Raposo ◽

...

Keyword(s):

Risk Factors ◽

Cohort Study ◽

Venous Thromboembolism ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Risk Classification ◽

Assessment Model ◽

Kappa Statistics ◽

Medical Patients ◽

Observer Reliability

Objectives To analyze the inter-observer reliability of risk for venous thromboembolism (VTE) in a population of adult acutely-ill medical patients. Methods In this prospective cohort study, we collected risk factors and risk classification for VTE using RAM IMPROVE7. Kappa statistics was used to evaluate inter-observer reliability between lead clinicians and trained researchers. We evaluated occurrence of VTE in patients with mismatched classification. Results We included 2,380 patients, median age 70 years (interquartile range [IQR], 58-79), 56.2% female. Adjusted Kappa for VTE risk factors ranged from substantial (0.64, 95% confidence interval [CI], 0.61-0.67) for “immobilization”, to almost perfect (0.98; 95% CI 0.97-0.99) for “thrombophilia”; risk classification was 0.64 (95% CI 0.60-0.67). Divergent risk classification occurred in 434 patients (18.2%) of whom seven (1.6%) developed VTE. Conclusion Despite substantial to almost perfect reliability between observers for risk factors and risk classification, lead clinicians tended to underestimate the risk for VTE.

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Psychiatry Transcript Annotation: Process Study and Improvements

Proceedings of the International Symposium on Human Factors and Ergonomics in Health Care ◽

10.1177/2327857921101030 ◽

2021 ◽

Vol 10 (1) ◽

pp. 71-75

Author(s):

Srinivasan Sridhar ◽

Nazmul Kazi ◽

Indika Kahanda ◽

Bernadette McCrory

Keyword(s):

Mental Health ◽

Work Experience ◽

Phase 1 ◽

Kappa Statistics ◽

Phase 2 ◽

Rater Reliability ◽

Standard Data ◽

Annotation Process ◽

Data Collection Process ◽

Two Phases

Background: The demand for psychiatry is increasing each year. Limited research has been performed to improve psychiatrist work experience and reduce daily workload using computational methods. There is currently no validated tool or procedure for the mental health transcript annotation process for generating “gold-standard” data. The purpose of this paper was to determine the annotation process for mental health transcripts and how it can be improved to acquire more reliable results considering human factors elements. Method: Three expert clinicians were recruited in this study to evaluate the transcripts. The clinicians were asked to fully annotate two transcripts. An additional five subjects were recruited randomly (aged between 20-40) for this pilot study, which was divided into two phases, phase 1 (annotation without training) and phase 2 (annotation with training) of five transcripts. Kappa statistics were used to measure the inter-rater reliability and accuracy between subjects. Results: The inter-rater reliability between expert clinicians for two transcripts were 0.26 (CI 0.19 to 0.33) and 0.49 (CI 0.42 to 0.57), respectively. In the pilot testing phases, the mean inter-rater reliability between subjects was higher in phase 2 with training transcript (k= 0.35 (CI 0.052 to 0.625)) than in phase 1 without training transcript (k= 0.29 (CI 0.128 to 0.451)). After training, the accuracy percentage among subjects was significantly higher in transcript A (p=0.04) than transcript B (p=0.10). Conclusion: This study focused on understanding the annotation process for mental health transcripts, which will be applied in training machine learning models. Through this exploratory study, the research found appropriate categorical labels that should be included for transcripts annotation, and the importance of training the subjects. Contributions of this case study will help the psychiatric clinicians and researchers in implementing the recommended data collection process to develop a more accurate artificial intelligence model for fully- or semi-automated transcript annotation.

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Inter-rater Reliability of a Classification System for Hospital Adverse Drug Event Reports

Clinical Pharmacology & Therapeutics ◽

10.1038/sj.clpt.6100322 ◽

2007 ◽

Vol 83 (3) ◽

pp. 485-488 ◽

Cited By ~ 5

Author(s):

K Haynes ◽

S Hennessy ◽

KH Morales ◽

GA Gibson ◽

C Barnhart ◽

...

Keyword(s):

Adverse Drug Event ◽

Classification System ◽

Drug Event ◽

Rater Reliability

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Abstract WP282: Protecting Stroke Patients from Aspiration and Mortality through a Bedside Aspiration Screen

Stroke ◽

10.1161/str.44.suppl_1.awp282 ◽

2013 ◽

Vol 44 (suppl_1) ◽

Author(s):

Edith Matesic

Keyword(s):

Organizational Learning ◽

Aspiration Pneumonia ◽

The Body ◽

Kappa Statistics ◽

Evidence Based ◽

Stroke Patients ◽

Rater Reliability ◽

Stroke Treatment ◽

Risk Of Death ◽

The Impact

Background: Stroke patients initially experience dysphagia approximately 42-76% of the time, putting them at high risk for developing aspiration pneumonia and increasing the risk of death threefold in the first 30 days following onset of the condition. Interventions to identify risk for aspiration pneumonia are key to reducing mortality in hospitalized patients. However, no generally recognized bedside aspiration screen exists, and few have been rigorously tested. The Edith-Huhn-Matesic Bedside Aspiration Screen (EHMBAS) TM was developed as an evidence-based RN bedside aspiration screening protocol. Purpose: This study analyzed the sensitivity and inter-rater reliability of EHMBAS TM , assessed the efficacy of training methods, evaluated patient feedback, and looked at the impact of organizational learning. Methods: RNs were trained to apply the EHMBAS TM . An evaluation study assessed the sensitivity, specificity and predictability of the screen to detect aspiration in the stroke population study group. Cohen’s Kappa statistics was applied to test inter-rater reliability. Pre- and post-implementation Likert surveys examined patient and staff satisfaction on the education plan and screening process, respectively. Lastly, an analysis of organizational learning examined whether changes enhanced adherence to screening requirements. Results: Results showed that the EHMBAS TM demonstrated strong validity (94% sensitivity) and high inter-rater reliability (Kappa = .92, p<.001). Pre- and post- staff training survey results demonstrated a significant positive change in knowledge gained, feelings of preparedness, and satisfaction with teaching methods. Further, 92.3% of patients surveyed had positive screening experiences. The hospital received Silver recognition from The American Heart Association for following stroke treatment guidelines 85% of the time for at least 12 months, demonstrating the positive impact of the protocol on organizational change. Conclusions: This study contributes to the body of work aimed at establishing a reliable evidence-based, bedside aspiration screen. Patient safety is enhanced, because screen results help determine when patients can safely receive medication and nutrition by mouth.

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USE CAUTION WHEN ASSESSING PRE-OPERATIVE LEG LENGTH DISCREPANCY IN PEDIATRIC PATIENTS WITH ANTERIOR CRUCIATE LIGAMENT INJURIES

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120s00284 ◽

2020 ◽

Vol 8 (4_suppl3) ◽

pp. 2325967120S0028

Author(s):

Lindsay M. Schlichte ◽

Peter D. Fabricant ◽

Christine Goodbody ◽

Daniel W. Green

Keyword(s):

Anterior Cruciate Ligament ◽

Pediatric Patients ◽

Cruciate Ligament ◽

Weight Bearing ◽

Acl Injury ◽

Leg Length ◽

Full Extension ◽

X Ray ◽

Length Discrepancy ◽

Anterior Cruciate

Background: Pre- and post-operative standing hip to ankle radiography is critical for monitoring potential post-operative growth arrest and resultant length and angular deformities after pediatric anterior cruciate ligament (ACL) reconstruction. During acquisition of pre-operative standing alignment radiographs, it is possible that patients are lacking full extension, not weight bearing comfortably, or leaning resulting in inaccurate measurements. Purpose: This study aims to assess both pre- and post-operative radiographic measurements to assess if the standing pre-operative x-ray is a accurate and reliable source for baseline measurements. Methods: We retrospectively reviewed prospectively collected pre-operative and first post-operative full-length hip-to-ankle radiographs in a cohort of skeletally immature athletes who presented with an acute ACL injury and underwent subsequent surgical reconstruction. Initially, leg length discrepancy for 25 patients was measured by 3 orthopedic surgeons (top of femoral head to center of tibial plafond). The intraclass correlation was almost perfect (ICC (2,1) = .996) therefore, 1 surgeon measured the remaining 94 radiographs. Measurements for both the injured and uninjured legs were obtained for comparison and surgeons were blinded to the injured side. Results: A total of 119 pediatric patients (mean age 13.4, range 7-14 years) were included (83 males and 36 females). Patient were categorized as either having ≥5mm, ≥10mm, or ≥15mm LLD on pre-operative standing x-ray. Sixty-two patients (52%) were found to have a pre-operative LLD ≥ 5mm. Forty-one (66%) of these patients tore their ACL on the limb measuring shorter. At 6 month post-operative standing x-ray, 35 patients (56%) resolved to ≤5mm LLD. Eighteen patients had a pre-operative LLD of ≥ 10mm. At 6 month post-operative standing x-ray, 13 (72%) patients resolved to ≤5mm LLD. Five patients had a pre-operative LLD of ≥ 15mm. At 6 month post-operative standing x-ray, 4 (80%) resolved ≤5mm. All patients with a pre-operative LLD of ≥ 13mm had sustained an ACL injury on the limb measuring shorter Conclusion: Of the pediatric ACL patients initially presenting with a pre-operative LLD of ≥ 10mm, 72% demonstrated apparent correction of their LLD on their 6 month standing x-ray. This high rate of LLD pre-operatively but not post operatively calls into question the accuracy of pre-operative standing alignment radiographs for patients after an ACL tear. Surgeons and radiology technicians should be aware of injured patients potentially lacking full extension, leaning, or not weight bearing comfortably, and should consider delaying preoperative radiographic length and alignment analysis until after the patient is able to fully straighten the injured knee and weight bear comfortably.

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ASSESSMENT OF VITAMIN D THERAPY EFFECT ON INFLAMMATORY MARKERS IN PEDIATRIC PATIENTS WITH TYPE I DIABETIC

Asian Journal of Pharmaceutical and Clinical Research ◽

10.22159/ajpcr.2018.v11i10.28936 ◽

2018 ◽

Vol 11 (10) ◽

pp. 552 ◽

Cited By ~ 1

Author(s):

Kadhim Ali Kadhim ◽

Lubab Tarek Nafea ◽

Hayder A Fawzi ◽

Esraa Abdul-al Hameed ◽

Gaith Ali Gasim

Keyword(s):

Vitamin D ◽

Serum Calcium ◽

Vitamin D3 ◽

Pediatric Patients ◽

Serum Vitamin ◽

Type I ◽

Insulin Regimen ◽

Newly Diagnosed ◽

Daily Insulin ◽

Therapy Effect

Objective: The objective of this study is to estimate the effect of Vitamin D3 supplementation on endogenous Vitamin D3 level and inflammatory biomarkers in newly diagnosed pediatric patients.Methods: The patients were given oral Vitamin D3, and they divided into three groups: The first group (25 healthy pediatrics), the second group (25 newly diagnosed pediatric patients) treated with daily insulin regimen only, and the third group (25 newly diagnosed pediatric patients) treated with Vitamin D3 (2000 IU/day) with daily insulin regimen; all patients were treated for 90 days; and blood samples were taken at baseline and after 45 days and 90 days of starting Vitamin D3 to assess its potential effect on the levels of Vitamin D, serum calcium, serum alkaline phosphatase levels, and other inflammatory markers.Results: The results of the current study showed that serum IL-1β significantly declined in patients receiving Vitamin D3, while serum Vitamin D3, serum calcium, and interleukins-4 were significantly increased in patients receiving Vitamin D3.Conclusion: Vitamin D3 in a daily dose of 2000 IU/day for 90 days results in favorable immune response and increase of serum Vitamin D3 for pediatric new diagnosed Type 1 diabetes mellitus patients.

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