Interrater and Intrarater Reliability of the Kuntz et al New Deformity Classification System

Neurosurgery ◽  
2012 ◽  
Vol 71 (1) ◽  
pp. 47-57 ◽  
Author(s):  
Martin Thaler ◽  
Ricarda Lechner ◽  
Michaela Gstöttner ◽  
Matthias Luegmair ◽  
Michael Liebensteiner ◽  
...  
Keyword(s):  
Classification System ◽  
Interobserver Agreement ◽  
Intraobserver Agreement ◽  
Spinal Alignment ◽  
Intrarater Reliability ◽  
Surgical Interventions ◽  
Apical Vertebral Rotation ◽  
Age Dependent ◽  
The Mean

Abstract BACKGROUND: Kuntz et al recently introduced a new system for classifying spinal deformities. This classification of spinal deformity was developed from age-dependent deviations from the neutral upright spinal alignment. OBJECTIVE: To determine the interobserver and intraobserver reliabilities of the new Kuntz et al system for classifying scoliosis. METHODS: Fifty consecutive patients were evaluated. Three observers independently assigned a major structural curve, minor structural curve, curve type, apical vertebral rotation, spinal balance, and pelvic alignment to each curve following the guidelines described by Kuntz et al. Assignment of the curves was repeated 4 weeks later, with the curves presented in a different blinded order. The Kendall W and Holsti agreement coefficients were used to determine the interobserver and intraobserver agreement. RESULTS: The intraobserver value of agreement for all parameters was 0.85 (range, 0.28-1.0), and the mean Kendall W coefficient was 0.89 (range, 0.5-0.97), demonstrating perfect reliability. The interobserver agreement averaged 0.7 (range, 0.251-1.0). The mean Kendall W coefficient was 0.67 (range, 0.19-1.0), demonstrating substantial reliability. The average time for classification of 1 curve was approximately 8.4 minutes. CONCLUSION: The new Kuntz et al deformity classification system is comparable to the Lenke et al system in terms of reliability. However, the Kuntz et al classification system provides no recommendations for surgical interventions. It is more complex and time-consuming and therefore may be of limited value in daily clinical practice.

Interobserver Agreement and Intraobserver Reproducibility of Barzullah Working Classification of Distal End Radius Fractures among Orthopaedic Residents

2016 ◽  
Vol 21 (01) ◽  
pp. 24-29 ◽  
Author(s):  
Younis Kamal ◽  
Hayat Ahmad Khan ◽  
Naseem UI Gani ◽  
Munir Farooq ◽  
Adil Bashir Shah ◽  
...  
Keyword(s):  
Distal Radius ◽  
Interobserver Agreement ◽  
Distal Radius Fractures ◽  
Substantial Agreement ◽  
Radius Fractures ◽  
Intraobserver Reproducibility ◽  
Moderate Agreement ◽  
Kappa Value ◽  
The Mean

Background: The purpose of this study is to test the hypothesis of the new classification system of distal end radius fractures (Barzullah working classification) proposed by one of the author in a prospective cohort study, among the orthopaedic residents. Methods: The initial post-injury radiographs of 300 patients with distal radius fractures in a tertiary centre were classified by two junior residents (JR1 and JR2) and two senior residents (SR1 and SR2) in the emergency department over a period of two years. The collected data was analysed statistically by using Cohan's kappa for measuring Intraobserver reproducibility and Fleiss kappa for measuring Interobserver agreement. Results: The mean kappa value for Interobserver agreement was 0.53 (moderate agreement) at the end of one year and the mean kappa value at the end of study period was 0.64 (substantial agreement). The mean kappa value for Intraobserver reproducibility of JR1 was 0.45 (moderate agreement), JR2 was 0.39 (fair agreement), SR1 was 0.62 (substantial agreement) and SR2 was 0.67 (substantial agreement). Conclusions: Barzullah working classification of distal radius fractures presented in this study has good characteristics compared to those of already studied classification systems among orthopaedic residents.

scholarly journals Intra and Inter-observer Concordance of a New Classification System for Myopic Maculopathy

2020 ◽  
Author(s):  
Rong-rong Zhang ◽  
Yan Yu ◽  
Yin-fen Hou ◽  
Chang-fan Wu
Keyword(s):  
Classification System ◽  
Clinical Decision Making ◽  
Interobserver Reliability ◽  
Type A ◽  
Clinical Decision ◽  
Intraobserver Agreement ◽  
Intraobserver Reproducibility ◽  
Fundus Photographs ◽  
Myopic Maculopathy

Abstract Background: Myopic maculopathy (MM) is one of the major causes of visual impairment and irreversible blindness in eyes with PM. However, the classification of each type of lesion associated with MM has not been determined. Recently, a new MM classification system was proposed, known as the ATN grading and classification system, which was based on the fundus photographs and OCT images, including three variable components: atrophy (A), traction (T), and neovascularization (N). Hence, this study aimed to perform an independent interobserver and intraobserver agreement evaluation of the recently developed ATN grading system for MM. Methods: This was a retrospective study. Fundus photographs and the optical coherence tomography (OCT) images of 125 patients (226 eyes) with various of MM were evaluated and classified using the ATN grading of the new MM classification system by four evaluators (2 attending ophthalmologists and 2 ophthalmic residents). All cases were repeatedly evaluated by the same evaluators after an interval of 6 weeks. The Kappa coefficient (κ) and 95% confidence interval (CI) were used to determine the interobserver and intraobserver agreement.Results: The interobserver reliability was substantial when considering the maculopathy type (A, T, and N). The weighted Fleiss κ values for each MM type (A, T, and N) were 0.651 (95% CI: 0.602–0.700), 0.734 (95% CI: 0.689–0.779), and 0.702 (95% CI: 0.649–0.755), respectively. The interobserver agreement when considering the sub-types was good or excellent, except for stages A1, A2, and N1 which weighted κ value was less than 0.6, with a moderate agreement. The intraobserver reproducibility of types or sub-types was excellent, with κ>0.8. No significant differences were observed between attending ophthalmologists and residents in the interobserver reliability and intraobserver reproducibility.Conclusions: The ATN classification allows an adequate agreement among ophthalmologists with different qualifications and by the same observer on separate occasions. Future prospective studies should further evaluate whether this classification can be better implemented at clinical decision-making and disease progression assessment.

Validity of the Novel Radiological Classification System of the Distal Femur

2021 ◽  
Author(s):  
Mustafa Akkaya ◽  
Mehmet Emin Simsek ◽  
Serhat Akcaalan ◽  
Ceyhun Caglar ◽  
Safa Gursoy ◽  
...  
Keyword(s):  
Knee Arthroplasty ◽  
Classification System ◽  
Interobserver Agreement ◽  
Distal Femur ◽  
Intraobserver Agreement ◽  
Alpha Coefficient ◽  
Cronbach’S Alpha ◽  
Cronbach's Alpha ◽  
Percent Agreement ◽  
Radiological Classification

Abstract Objective Aseptic loosening (AL) is among the most important causes of failure after total knee arthroplasty (TKA). However, while there are numerous underlying causes of AL, the morphometry of the distal femur and intramedullary canal has not been sufficiently demonstrated. This study aimed to show the interobserver and intraobserver reliability and validity of the Citak classification, which has been recently defined according to the morphometry of the distal femur and provides a risk factor definition for AL. Materials and Methods A total of 200 patients whose standardized anteroposterior (AP) and lateral images of the knee joint were obtained between October 2019 and April 2020 were retrospectively evaluated in this study. Patients with a history of extra-articular deformity and knee surgery were excluded from the study. For AL, morphologies of the distal femur were identified by two observers using the new radiological classification system of the distal femur. Mean pairwise Cronbach’s alpha coefficient was used to assess the intra- and interobserver agreement of the classification. Results There was excellent interobserver agreement for the 20 cm proximal and 2 cm proximal to the lateral joint line (PLJL) and adductor tubercle (PAD), respectively. The mean Cronbach’s alpha coefficient was 0.96 (range 0.764–0.944) for the PAD and 0.98 (range 0.734–0.929) for the PLJL. There was also an excellent intraobserver agreement, with 93% average pairwise percent agreement for the index group and 95.5% average pairwise percent agreement for the anatomical classification group. Conclusions The level of inter- and intraobserver agreement for the morphology of the distal femur was excellent in the new radiological classification system, which was shown to be beneficial in the planning of revision knee arthroplasty for AL. However, there is a need for further studies in order to make a correlation of the classification with specific intraoperative findings.

A Classification-System Improves the Intra- and Interobserver Reliability of Radiographic Diagnosis of “Pistol-Grip-Deformity”

2011 ◽  
Vol 21 (6) ◽  
pp. 732-739 ◽  
Author(s):  
Ingmar Ipach ◽  
Eva-Maria Arlt ◽  
Falk Mittag ◽  
Beate Kunze ◽  
Petra Wolf ◽  
...  
Keyword(s):  
Lower Limit ◽  
Classification System ◽  
Interobserver Reliability ◽  
Alpha Angle ◽  
Treatment Algorithm ◽  
Kappa Coefficient ◽  
Intraobserver Agreement ◽  
Single Plane ◽  
Upper Limit

Early detection of pistol-grip-deformity may be beneficial in optimising the outcome and the cost effectiveness of surgery. It is important to identify reliable radiographic parameters in assessing femoro-acetabular impingement (FAI) to develop a treatment algorithm. Radiographs of 47 patients ranging from “pistol grip deformity” to a normal head-neck-junction were measured for alpha angle and head ratio, and then classified by two different observers. The Bland-Altman plot was used for inter- and intraobserver agreement of alpha angle and head ratio. Inter- and intraobserver agreement for classification of “pistol grip deformity” was determined using weighted Cohen's kappa coefficient. Observer I achieved a kappa coefficient of 0.97. Observer II achieved a kappa coefficient of 0.92. An interobserver kappa coefficient between 0.87 and 0.92 was achieved by using a classification system. By testing for interobserver agreement, a bias of –0.004 with an upper limit of 0.461 and a lower limit of –0.47 was seen for the ratio and a bias of –3.7 with an upper limit of 17.2 and a lower limit of –24.6 for the alpha angle. Therefore, poor results were seen for intra- and interobserver reliability by using only a single plane for classification of “pistol grip deformity”. The strength of agreement could be improved by using a classification system (based on two planes).

Reproducibility and Reliability of the Outerbridge Classification for Grading Chondral Lesions of the Knee Arthroscopically

2003 ◽  
Vol 31 (1) ◽  
pp. 83-86 ◽  
Author(s):  
Michelle L. Cameron ◽  
Karen K. Briggs ◽  
J. Richard Steadman
Keyword(s):  
Classification System ◽  
Cadaver Study ◽  
Kappa Coefficient ◽  
Chondral Lesions ◽  
Orthopaedic Surgeons ◽  
Diagnostic Arthroscopy ◽  
Chondral Damage ◽  
The Mean ◽  
Level Of Experience

Background Few studies have investigated the accuracy and reproducibility of the Outerbridge classification system for classification of chondral damage in the knee. Hypothesis Arthroscopically assigned Outerbridge grades are accurate, reliable, and reproducible. Study Design Cadaver study. Methods Six cadaveric knees underwent diagnostic arthroscopy, which was videotaped. An arthrotomy was then performed and the arthroscopically identified lesions were measured with calipers. Nine orthopaedic surgeons reviewed each video and graded each chondral lesion two separate times. Accuracy of observations was calculated based on the percentage of agreement between the grades determined during arthroscopy and arthrotomy. Results The overall accuracy was 68% but varied by location. The kappa coefficient between the two scores was 0.602; the arthroscopy grade was higher than the arthrotomy grade 63% of the time. The intraobserver and interobserver kappa coefficients were 0.80 and 0.52, respectively. The mean interobserver kappa between the two physicians in practice 5 years or more was 0.72, compared with 0.50 for physicians in practice less than 5 years. Conclusions The Outerbridge classification was moderately accurate when used to grade chondral lesions arthroscopically. Clinical Relevance Orthopaedic surgeons can accurately grade chondral lesions of the knee with the Outerbridge classification, regardless of their level of experience.

scholarly journals Independent Reliability Analysis of a New Classification for Pyogenic Spondylodiscitis

2020 ◽  
pp. 219256822091909
Author(s):  
Gaston Camino Willhuber ◽  
Alfredo Guiroy ◽  
Juan Zamorano ◽  
Nelson Astur ◽  
Marcelo Valacco
Keyword(s):  
Reliability Analysis ◽  
Interobserver Agreement ◽  
Random Sequence ◽  
Diagnostic Study ◽  
Intraobserver Agreement ◽  
Resonance Imaging ◽  
New Classification ◽  
Level Of Evidence ◽  
Pyogenic Spondylodiscitis

Study Design: Diagnostic study, level of evidence III. Objective: Pyogenic spondylodiscitis can cause deformity, neurological compromise, disability, and death. Recently, a new classification of spondylodiscitis based on magnetic resonance imaging was published. The objective of this study is to perform an independent reliability analysis of this new classification. Methods: We selected 35 cases from our database of different spine centers in Latin America and from the literature; 8 observers evaluated the classification and graded the scenarios according to the methodological grading of the classification developed by Pola et al. Cases were sent to the observers in a random sequence after 3 weeks to assess intraobserver reliability. The interobserver and intraobserver reliabilities were performed with Fleiss and Cohen statistics, respectively. Results: The overall Fleiss κ value for interobserver agreement was substantial, with 0.67 (95% CI = 0.43-0.91) in the first reading and 0.67 (95% CI = 0.45-0.89) in second reading for the main types of classification. The Cohen κ value for intraobserver agreement was also substantial, with 0.68 (95% CI = 0.45-0.92). The interobserver agreement analysis for the subtypes of this classification was overall substantial, with 0.60 (95% CI = 0.37-0.83) in the first reading and 0.61 (95% CI = 0.41-0.81) in the second reading. The overall intraobserver agreement for subtypes of the classification was also substantial, with 0.63 (95% CI = 0.34-0.93). Conclusion: The new classification developed by Pola et al showed substantial interobserver and intraobserver agreements. More studies are required to validate the usefulness of this classification especially in clinical practice.

scholarly journals Interobserver Agreement in the Classification of Partial-Thickness Rotator Cuff Tears Using the Snyder Classification System

2016 ◽  
Vol 4 (9) ◽  
pp. 232596711666705 ◽  
Author(s):  
Christopher S. Lee ◽  
Shane M. Davis ◽  
Brittany Doremus ◽  
Shalen Kouk ◽  
William B. Stetson
Keyword(s):  
Rotator Cuff ◽  
Classification System ◽  
Interobserver Agreement ◽  
Rotator Cuff Tears ◽  
Partial Thickness

scholarly journals The Oswestry-Bristol Classification

2020 ◽  
Vol 102-B (1) ◽  
pp. 102-107 ◽  
Author(s):  
Nikhil Sharma ◽  
Ashley Brown ◽  
Theodoros Bouras ◽  
Jan H. Kuiper ◽  
Jonathan Eldridge ◽  
...  
Keyword(s):  
Classification System ◽  
Interobserver Agreement ◽  
Trochlear Dysplasia ◽  
Significant Risk ◽  
Patellofemoral Instability ◽  
Kappa Statistic ◽  
Significant Risk Factor ◽  
Classification Systems ◽  
Intraobserver Agreement ◽  
Dejour Classification

Aims Trochlear dysplasia is a significant risk factor for patellofemoral instability. The Dejour classification is currently considered the standard for classifying trochlear dysplasia, but numerous studies have reported poor reliability on both plain radiography and MRI. The severity of trochlear dysplasia is important to establish in order to guide surgical management. We have developed an MRI-specific classification system to assess the severity of trochlear dysplasia, the Oswestry-Bristol Classification (OBC). This is a four-part classification system comprising normal, mild, moderate, and severe to represent a normal, shallow, flat, and convex trochlear, respectively. The purpose of this study was to assess the inter- and intraobserver reliability of the OBC and compare it with that of the Dejour classification. Methods Four observers (two senior and two junior orthopaedic surgeons) independently assessed 32 CT and axial MRI scans for trochlear dysplasia and classified each according to the OBC and the Dejour classification systems. Assessments were repeated following a four-week interval. The inter- and intraobserver agreement was determined by using Fleiss’ generalization of Cohen’s kappa statistic and S-statistic nominal and linear weights. Results The OBC showed fair-to-good interobserver agreement and good-to-excellent intraobserver agreement (mean kappa 0.68). The Dejour classification showed poor interobserver agreement and fair-to-good intraobserver agreement (mean kappa 0.52) Conclusion The OBC can be used to assess the severity of trochlear dysplasia. It can be applied in clinical practice to simplify and standardize surgical decision-making in patients with recurrent patella instability. Cite this article: Bone Joint J 2020;102-B(1):102–107

scholarly journals Magnetic Resonance Imaging Score and Classification System (AMADEUS) for Assessment of Preoperative Cartilage Defect Severity

Cartilage ◽  
2016 ◽  
Vol 8 (3) ◽  
pp. 272-282 ◽  
Author(s):  
Pia M. Jungmann ◽  
Götz H. Welsch ◽  
Mats Brittberg ◽  
Siegfried Trattnig ◽  
Sepp Braun ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Cartilage Repair ◽  
Subchondral Bone ◽  
Cartilage Defect ◽  
Classification System ◽  
Interobserver Agreement ◽  
Defect Size ◽  
Area Measurement ◽  
Mr Images ◽  
The Mean

Objective To design a simple magnetic resonance (MR)–based assessment system for quantification of osteochondral defect severity prior to cartilage repair surgery at the knee. Design The new scoring tool was supposed to include 3 different parameters: (1) cartilage defect size, (2) depth/morphology of the cartilage defect, and (3) subchondral bone quality, resulting in a specific 3-digit code. A clearly defined numeric score was developed, resulting in a final score of 0 to 100. Defect severity grades I through IV were defined. For intra- and interobserver agreement, defects were assessed by 2 independent readers on preoperative knee MR images of n = 44 subjects who subsequently received cartilage repair surgery. For statistical analyses, mean values ± standard deviation (SD), interclass correlation coefficients (ICC), and linear weighted kappa values were calculated. Results The mean total Area Measurement And DEpth & Underlying Structures (AMADEUS) score was 48 ± 24, (range, 0-85). The mean defect size was 2.8 ± 2.6 cm2. There were 36 of 44 full-thickness defects. The subchondral bone showed defects in 21 of 44 cases. Kappa values for intraobserver reliability ranged between 0.82 and 0.94. Kappa values for interobserver reliability ranged between 0.38 and 0.85. Kappa values for AMADEUS grade were 0.75 and 0.67 for intra- and interobserver agreement, respectively. ICC scores for the AMADEUS total score were 0.97 and 0.96 for intra- and interobserver agreement, respectively. Conclusions The AMADEUS score and classification system allows reliable severity encoding, scoring and grading of osteochondral defects on knee MR images, which is easily clinically applicable in daily practice.

scholarly journals REPRODUCIBILITY OF MODIFIED WALDENSTRÖM CLASSIFICATION IN PERTHES DISEASE

2021 ◽  
Vol 29 (2) ◽  
pp. 92-96
Author(s):  
FELIPPI GUIZARDI CORDEIRO ◽  
PATRICIA MORENO GRANGEIRO ◽  
BRUNO SÉRGIO FERREIRA MASSA ◽  
NEI BOTTER MONTENEGRO ◽  
ROBERTO GUARNIERO
Keyword(s):  
Classification System ◽  
Reasonable Agreement ◽  
Interobserver Agreement ◽  
Interobserver Reliability ◽  
Perthes Disease ◽  
Intraobserver Agreement ◽  
Level Of Evidence ◽  
Resident Physicians ◽  
Kappa Value ◽  
Kendall’S W

ABSTRACT Objective: The purpose of our study is to evaluate intraobserver and interobserver reliability of modified Waldenström classification system for Legg-Calvé-Perthes disease and assess the influence of the professional’s area of expertise in the assessment. Methods: Twelve evaluators assessed 40 pairs of pelvic radiographs of patients with Legg-Calvé-Perthes disease. After two weeks, a new evaluation was performed by the same evaluators. Kappa and Kendall’s W indexes were used to evaluate both intraobserver and interobserver reliability and determine the influence of the evaluators’ experience and area of expertise. Results: The average intraobserver kappa value was 0.394, with a reasonable agreement level. The interobserver Kappa value was 0.243 in the first evaluation (95% CI, 0.227-0.259 and p < 0.0001) and 0.245 in the second evaluation (95% CI, 0.229-0.260 and p < 0.0001). The Kendall’s W values obtained for pediatric orthopedists, radiologists and resident physicians were 0.686, 0.630 and 0.529 (p < 0.0001), respectively. Conclusion: The modified Waldenström classification presented both moderate and reasonable levels of intraobserver agreement, and reasonable level of interobserver agreement. The evaluators’ degree of experience and area of expertise influenced the concordance level found. Level of Evidence II, Diagnostic Studies - Investigating a Diagnostic Test.

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