Intrarater and interrater reliability and validity in the assessment of the mechanism of injury and integrity of the posterior ligamentous complex: a novel injury severity scoring system for thoracolumbar injuries

ObjectA new classification and treatment algorithm for thoracolumbar injuries was recently introduced by Vaccaro and colleagues in 2005. A thoracolumbar injury severity scale (TLISS) was proposed for grading and guiding treatment for these injuries. The scale is based on the following: 1) the mechanism of injury; 2) the integrity of the posterior ligamentous complex (PLC); and 3) the patient’s neurological status. The reliability and validity of assessing injury mechanism and the integrity of the PLC was assessed.MethodsForty-eight spine surgeons, consisting of neurosurgeons and orthopedic surgeons, reviewed 56 clinical thoracolumbar injury case histories. Each was classified and scored to determine treatment recommendations according to a novel classification system. After 3 months the case histories were reordered and the physicians repeated the exercise. Validity of this classification was good among reviewers; the vast majority (> 90%) agreed with the system’s treatment recommendations. Surgeons were unclear as to a cogent description of PLC disruption and fracture mechanism.ConclusionsThe TLISS demonstrated acceptable reliability in terms of intra- and interobserver agreement on the algorithm’s treatment recommendations. Replacing injury mechanism with a description of injury morphology and better definition of PLC injury will improve inter- and intraobserver reliability of this injury classification system.

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Thoracolumbar Injury Severity Scoring Systems: A Review and Rationale for a New System Based on the AOSpine Thoracolumbar Injury Classification System

International Journal of Physical Medicine & Rehabilitation ◽

10.4172/2329-9096.1000257 ◽

2015 ◽

Vol 03 (02) ◽

Author(s):

Robyn Rubenstein John D Koerner

Keyword(s):

Classification System ◽

Injury Severity ◽

Scoring Systems ◽

Severity Scoring ◽

Thoracolumbar Injury ◽

Injury Classification ◽

New System

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Reliability and Validity of the AOSpine Thoracolumbar Injury Classification System: A Systematic Review

Global Spine Journal ◽

10.1177/2192568218806847 ◽

2018 ◽

Vol 9 (2) ◽

pp. 231-242 ◽

Cited By ~ 7

Author(s):

Aidin Abedi ◽

Lidwine B. Mokkink ◽

Shayan Abdollah Zadegan ◽

Permsak Paholpak ◽

Koji Tamai ◽

...

Keyword(s):

Systematic Review ◽

Classification System ◽

Methodological Quality ◽

Reliability And Validity ◽

Measurement Properties ◽

Moderate Evidence ◽

Thoracolumbar Injury ◽

Injury Classification ◽

Morphologic Classification

Study Design: Systematic review. Objectives: The AOSpine thoracolumbar injury classification system (ATLICS) is a relatively simple yet comprehensive classification of spine injuries introduced in 2013. This systematic review summarizes the evidence on measurement properties of this new classification, particularly the reliability and validity of the main morphologic injury types with and without inclusion of the subtypes. Methods: A literature search was performed using PubMed and Embase in September 2016. A revised version of the COSMIN checklist was used for evaluation of the quality of studies. Two independent reviewers performed all steps of the review. Results: Nine articles were included in the final review, all of which evaluated the reliability of the ATLICS and had a fair methodological quality. The reliability of the modifiers was unknown. Overall, the quality of evidence for reliability of the morphologic and neurologic classification sections was low. However, there was moderate evidence for poor interobserver reliability of the morphologic classification when all subtypes were included, and moderate evidence for good intraobserver reliability with exclusion of subtypes. The reliability of the morphologic classification was independent of the observer’s experience and cultural background. Conclusions: ATLICS represents the most current system for evaluation of thoracolumbar injuries. Based on this review, further studies with robust methodological quality are needed to evaluate the measurement properties of ATLICS. Shortcomings of the reliability studies are discussed.

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The Reliability and Validity of the Thoracolumbar Injury Classification System in Pediatric Spine Trauma

Spine ◽

10.1097/brs.0000000000001011 ◽

2015 ◽

Vol 40 (18) ◽

pp. E1014-E1018 ◽

Cited By ~ 16

Author(s):

Jason W. Savage ◽

Timothy A. Moore ◽

Paul M. Arnold ◽

Nikhil Thakur ◽

Wellington K. Hsu ◽

...

Keyword(s):

Classification System ◽

Reliability And Validity ◽

Pediatric Spine ◽

Spine Trauma ◽

Thoracolumbar Injury ◽

Pediatric Spine Trauma ◽

Injury Classification

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MRI Inter-Reader and Intra-Reader Reliabilities for Assessing Injury Morphology and Posterior Ligamentous Complex Integrity of the Spine According to the Thoracolumbar Injury Classification System and Severity Score

Korean Journal of Radiology ◽

10.3348/kjr.2015.16.4.889 ◽

2015 ◽

Vol 16 (4) ◽

pp. 889 ◽

Cited By ~ 4

Author(s):

Guen Young Lee ◽

Joon Woo Lee ◽

Seung Woo Choi ◽

Hyun Jin Lim ◽

Hye Young Sun ◽

...

Keyword(s):

Classification System ◽

Severity Score ◽

Posterior Ligamentous Complex ◽

Thoracolumbar Injury ◽

Injury Classification

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The Reliability and Validity of the Thoraco-Lumbar Injury Classification and Severity score

QJM ◽

10.1093/qjmed/hcaa055.003 ◽

2020 ◽

Vol 113 (Supplement_1) ◽

Author(s):

I H Sabry ◽

A F Toubar ◽

O A Ahmed ◽

M I Alashwal

Keyword(s):

Interrater Reliability ◽

Reliability And Validity ◽

Treatment Recommendations ◽

Treatment Recommendation ◽

Spearman Correlation ◽

Intrarater Reliability ◽

Correct Treatment ◽

Posterior Ligamentous Complex ◽

Neurologic Status ◽

Injury Classification

Abstract Background The TLICS/TLISS is a recently introduced classification system for thoracolumbar spinal column injures designed to simplify injury classification and facilitate treatment decision making. Before being widely adopted, the reliability and validity of the TLICS/TLISS must be studied. Aim of the Work To determine the interrater and intrarater reliability and the validity of the TLICS score and its predecessor the TLISS scoring system in the clinical practice. Patients and Methods A total of 7 articles with 10 datasets were used to test the inter- and intrarater reliability and validity of the TLICS/TLISS score for thoracolumbar spine trauma. Included studies presented Thoracolumbar trauma cases’ details (including clinical data, plain radiographs, CT scans and MRI) to spine surgeons allowing them to score them using the TLICS/TLISS score in each of its components (neurologic status, PLC integrity and fracture morphology/mechanism), the final score and surgeons’ agreement with the scores treatment recommendations; as well as comparing the treatment recommendations (surgical vs non-surgical management) with the treatment the patients actually received. At a later time the surgeons were assigned the task with the cases reordered. The interrater reliability, as well as the intrarater reliability of the score for each component and sum, were evaluated by Cohen’s unweighted k-value and Spearman’s rank order correlation. In addition, the sensitivity and specificity of the score (validity) were evaluated by the percent of correct treatment recommendations according to the sum of the TLICS/TLISS and the treatment actually received by the patients. Results Interrater reliability assessed by generalized kappa coefficients was 0.45 ±0.17 for injury morphology/mechanism, 0.91 ±0.03 for neurologic status, 0.42 ±0.13 for posterior ligamentous complex status, 0.36 ±0.14 for TLICS/TLISS total, and 0.59 ±0.10 for treatment recommendation. Respective results using the Spearman correlation were 0.52 ±0.18, 0.95 ±0.05, 0.57 ±0.13, 0.75 ±0.10, and 0.64 ±0.20. Intrarater kappa coefficients were 0.53 ±0.14 for injury morphology/mechanism, 0.89 ±0.07 for neurologic status, 0.53 ±0.15 for posterior ligamentous complex status, 0.46 ±0.16 for TLICS/TLISS total, and 0.61 ±0.02 for treatment recommendation. Respective results using the Spearman correlation were 0.63 ±0.08, 0.90 ±0.03, 0.64 ±0.10, 0.77 ±0.03, and 0.60 ±0.02. The percent of correct treatment recommendation by the score and the treatment actually received by the patients was 94.4% ±1.5, with sensitivity of 0.91 ±0.06, specificity of 0.94 ±0.01, PPV of 0.94 ±0.01, NPV of 0.93 ±0.02. Conclusions The TLICS/TLISS score has good reliability and validity and it compares favorably to other contemporary and old thoracolumbar fracture classification systems.

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