Accuracy and agreement of national spine register data for 474 patients compared to corresponding electronic patient records

Purpose Data quality is essential for all types of research, including health registers. However, data quality is rarely reported. We aimed to assess the accuracy of data in a national spine register (NORspine) and its agreement with corresponding data in electronic patient records (EPR). Methods We compared data in NORspine registry against data in (EPR) for 474 patients operated for spinal stenosis in 2015 and 2016 at four public hospitals, using EPR as the gold standard. We assessed accuracy using the proportion correctly classified (PCC) and sensitivity. Agreement was quantified using Kappa statistics or interaclass correlation coefficient (ICC). Results The mean age (SD) was 66 (11) years, and 54% were females. Compared to EPR, surgeon-reported perioperative complications displayed weak agreement (kappa (95% CI) = 0.51 (0.33–0.69)), PCC of 96%, and a sensitivity (95% CI) of 40% (23–58%). ASA classification had a moderate agreement (kappa (95%CI) = 0.73 (0.66–0.80)). Comorbidities were underreported in NORspine. Perioperative details had strong to excellent agreements (kappa (95% CI) ranging from 0.76 ( 0.68–0.84) to 0.98 (0.95–1.00)), PCCs between 93% and 99% and sensitivities (95% CI) between 92% (0.84–1.00%) and 99% (0.98–1.00%). Patient-reported variables (height, weight, smoking) had excellent agreements (kappa (95% CI) between 0.93 (0.89–0.97) and 0.99 (0.98–0.99)). Conclusion Compared to electronic patient records, NORspine displayed weak agreement for perioperative complications, moderate agreement for ASA classification, strong agreement for perioperative details, and excellent agreement for height, weight, and smoking. NORspine underreported perioperative complications and comorbidities when compared to EPRs. Patient-recorded data were more accurate and should be preferred when available.

Clinical Indoor Running Gait Analysis May Not Approximate Outdoor Running Gait Based on Novel Drone Technology

Background: Traditional running gait analysis is limited to artificial environments, but whether treadmill running approximates overground running is debated. This study aimed to compare treadmill gait analysis using fixed video with outdoor gait analysis using drone video capture. Hypothesis: Measured kinematics would be similar between natural outdoor running and traditional treadmill gait analysis. Study Design: Crossover study. Level of Evidence: Level 2. Methods: The study population included cross-country, track and field, and recreational athletes with current running mileage of at least 15 km per week. Participants completed segments in indoor and outdoor environments. Indoor running was completed on a treadmill with static video capture, and outdoor segments were obtained via drone on an outdoor track. Three reviewers independently performed clinical gait analysis on footage for 32 runners using kinematic measurements with published acceptable intra- and interrater reliability. Results: Of the 8 kinematic variables measured, 2 were found to have moderate agreement indoor versus outdoor, while 6 had fair to poor agreement. Foot strike at initial contact and rearfoot position at midstance had moderate agreement indoor versus outdoor, with a kappa of 0.54 and 0.49, respectively. The remaining variables: tibial inclination at initial contact, knee flexion angle initial contact, forward trunk lean full gait cycle, knee center position midstance, knee separation midstance, and lateral pelvic drop at midstance were found to have fair to poor agreement, ranging from 0.21 to 0.36. Conclusion: This study suggests that kinematics may differ between natural outdoor running and traditional treadmill gait analysis. Clinical Relevance: Providing recommendations for altering gait based on treadmill gait analysis may prove to be harmful if treadmill analysis does not approximate natural running environments. Drone technology could provide advancement in clinical running recommendations by capturing runners in natural environments.

Content Validation of a Semi-Structured Interview to Analyze the Management of Suffering

This work involves the content validation of a semi-structured interview, whose objective is to learn about the management of suffering in people. The interview items have been classified into several categories that define the suffering construct. For the content validation of the instrument, in addition to initially conducting a scientific review on the subject, the procedure known as expert judgement has been used. The results obtained in terms of the content validity achieved in the dimensions and areas assessed are, in general, satisfactory. However, some of these dimensions and certain areas have not exceeded the required minimum values for content validity. Therefore, it is necessary to modify the items comprising these dimensions in the areas evaluated with the additional incorporation of the qualitative suggestions for improvement indicated by the experts. As for agreement among experts, the results point to moderate agreement, which, moreover, is not due to chance.

Immunohistochemical comparison of three programmed death-ligand 1 (PD-L1) assays in triple-negative breast cancer

Background Triple-negative breast cancer (TNBC) is the most aggressive type of breast cancer. A recent study demonstrated the efficacy of anti-PD-L1 (anti-programmed death ligand-1) immunotherapy in patients with TNBC. However, the identification of TNBC patients who may benefit from immunotherapy is a critical issue. Several assays have been used to evaluate PD-L1 expression, and a few studies comparing PD-L1 expression using various primary antibodies in TNBC tissues have been reported. However, the expression profiles of the PD-L1 using the 73–10 assay have not yet been analyzed in TNBC tissues. Methods We analyzed the PD-L1 immunohistochemical profiles of 62 women with TNBC using the 73–10, SP142 (companion diagnostic for atezolizumab), and E1L3N assays. PD-L1 expression on immune cells (ICs) and tumor cells (TCs) was also evaluated, and PD-L1 positivity was defined as a PD-L1-expressing ICs or TCs ≥ 1%. Results The expression rates of PD-L1 were 79.0%, 67.7%, and 46.8% on ICs, and 17.7%, 6.5%, and 12.9% on TCs using the 73–10, SP142, and E1L3N assays, respectively. The concordance rates between the 73–10 and SP142 assays were 85.5% (on ICs) and 88.7% (on TCs), respectively, and substantial agreement on ICs (coefficient 0.634) and moderate agreement (coefficient 0.485) on TCs were noted. Sample age and tumor diameter did not influence the ratio of PD-L1 expression among the assays. Conclusions The positive rate on ICs and TCs of the 73–10 assay was higher than that of the SP 142 and E1L3N assays. Although substantial agreement on ICs and moderate agreement on TCs between the 73–10 and SP142 assays was noted in the present cohort, further studies are needed to clarify the PD-L1 expression status using various primary antibodies in a larger patient population. This would lead to the establishment of an effective evaluation method to assess the predictive value of anti-PD-L1 immunotherapy.

Concordance of skin test reactivity between indoor inhalant allergens among children with allergic respiratory disease

Background In vitro studies have demonstrated cross-reactivity among indoor allergen proteins in children with allergic respiratory diseases. However, there are only few studies evaluating in vivo response. A skin prick test (SPT) with commercial indoor solutions is widely used in clinical practice. We aimed to evaluate SPT agreement in children with allergic respiratory disease between pairs of common indoor allergens. Methods We reviewed SPT results of children 2 to 18 years old, diagnosed with respiratory allergic disease. Results from house dust mite (Dermatophagoides farinae, Dermatophagoides pteronyssinus), cockroach (Periplaneta americana, Blatella germanica), cat and dog were collected. Sensitization was defined as ≥ 3 mm in wheal diameter. Kappa coefficient (κ) was used to analyze sensitization concordance for each allergen pair. Results The charts of 300 children, 187 (62.33%) males, were reviewed. Mean age was 7.43 ± 3.29 years with 183 (61%), 140 (46.67%), 45 (15%), 30 (10%) sensitizations to house dust mite (HDM), cockroach, cat and dog, respectively. Sensitization concordance between HDM and cockroach was moderate: κ = 0.53 (95% CI: 0.42–0.64). Moderate agreement occurred between dog and cat: κ = 0.41 (95%CI: 0.30–0.52). HDM-sensitized children showed poor concordance with both cat κ = 0.17 (95%CI: 0.09–0.24) and dog κ = 0.09 (95%CI: 0.03–0.14). There was also poor concordance between cockroach-sensitized children to cat κ = 0.19 (95%CI; 0.11–0.28) and dog κ = 0.11 (95%CI; 0.04–0.18). Conclusion We demonstrated moderate agreement of SPT response between HDM and cockroach as well as dog and cat. This may be due to cross-reactivity. Component-resolved diagnosis should be considered in children with co-sensitization of these allergen pairs.

VARIABILITY IN EVALUATION AND TREATMENT OF PEDIATRIC TIBIAL TUBERCLE FRACTURES AMONGST PEDIATRIC ORTHOPAEDIC SURGEONS

Introduction: Tibial tubercle fractures are uncommon injuries typically seen in adolescents approaching skeletal maturity. No evidence based clinical practice guidelines currently exist regarding clinical management of both operative and nonoperative fractures. Purpose: To determine the variability in clinical management of tibial tubercle fractures among a group of pediatric orthopaedic surgeons. Methods: Nine fellowship trained academic pediatric orthopaedic surgeons reviewed 51 anteroposterior and lateral knee radiographs with associated case age (mean: 13.6yrs, range: 9-16yrs) and gender (86%male). Respondents were asked to describe each fracture using the Ogden classification (Type 1-5 with A/B modifiers), desired radiographic workup, operative vs. nonoperative treatment strategy, and plans for post treatment follow-up. Interrater reliability was determined among the surgeons using Fleiss Kappa analysis. Results: Fair agreement was reached when classifying the fracture type using the Ogden classification (k=0.39,p<0.001). There was slight agreement when determining if CT (k=0.10,p<0.001) should be ordered and when rating concern for compartment syndrome (k=0.17,p<0.001). Overall, surgeons had moderate agreement on whether to treat the fractures operatively vs. nonoperatively (k=0.51,p<0.001). Nonoperative management was selected for 80.4%(45/56) of Type 1A fractures. Respondents selected operative treatment for 75% (30/40) of Type 1B, 58.3% (14/24) of Type 2A, 97.4%(74/76) of Type 2B, 90.7%(39/43) of Type 3A, 96.3%(79/82) of Type 3B, 71.9%(87/121) of Type 4, and 94.1%(16/17) of Type 5 fractures. Regarding operative treatment, moderate agreement was reached when evaluating the emergent nature of the fracture (k=0.44,p<0.001) and surgical technique (k=0.44, p<0.001). However, only fair/slight agreement was reached when selecting the specifics of operative treatment including surgical fixation technique (k=0.25,p<0.001), screw type (k=0.26, p<0.001), screw size (k=0.08,p<0.001), use of washers (k=0.21,p<0.001), and performing a prophylactic anterior compartment fasciotomy (k=0.20,p<0.001). There was moderate agreement on radiographic work up at first (k=0.5,p<0.0011) and final (k=0.49,p<0.001) follow up visits. Surgeons had moderate agreement on plans to remove hardware (k=0.39,p<0.001). Non-operative treatment of fractures was observed to have only fair agreement (k=0.29,p<0.001). Furthermore, surgeons had fair/moderate agreement regarding the specifics of nonoperative treatment including degree of knee extension during immobilization (k=0.46,p<0.001), length of immobilization (k=0.34,p<0.001), post treatment weight bearing status (k=0.30,p<0.001), and post treatment rehabilitation (k=0.34,p<0.001). Finally, there was moderate agreement on radiographic work up at first (k=0.51,p<0.001) and final follow up (k=0.46,p<0.001). Conclusion: Significant variability exists between surgeons when evaluating and treating pediatric tibial tubercle fractures. Future studies should aim to create best practice guidelines for pediatric orthopaedic surgeons to reference when treating these fractures. [Table: see text]

An assessment of the psychometric properties of the Stoplight Pain Scale in a Canadian paediatric emergency department

Objective This study aimed to validate a novel, three faced, colour-coded, action-oriented tool: The Stoplight Pain Scale (SPS). Methods A prospective observational cohort study was conducted at a Canadian paediatric emergency department from November 2014 to February 2017. Patients aged 3 to 12 years and their caregivers were asked to rate pain using the SPS and the Faces Pain Scale-Revised (FPS-R). Pain was measured just before analgesia administration, 30 minutes after analgesia administration, and immediately following a painful procedure. Results A total of 227 patients were included; 26.9% (61/227) were 3 to 5 years old while 73.1% (166/227) were 6 to 12 years old. Using Cohen’s κ, agreement for SPS and FPS-R was ‘fair’ for children (0.28 [95% confidence interval {CI} 0.20 to 0.36]) and ‘poor’ for caregivers (0.14 [95% CI 0.07 to 0.21]), at initial measurement. The SPS had ‘fair’ agreement between child and caregiver scores, (0.37 [95% CI 0.27 to 0.47]), compared to FPS-R which showed ‘poor’ agreement (0.20 [95% CI 0.12 to 0.29]). Absolute agreement between child and caregiver SPS scores improved with repeat exposure; 30 minutes after analgesia administration, caregivers and children had fair agreement (κ=0.38, 95% CI 0.28 to 0.48); they had moderate agreement directly following painful procedures (κ=0.46, 95% CI 0.34 to 0.59). Overall, 72.4% (139/192) of children and 60.2% (118/196) of caregivers preferred SPS over FPS-R. Conclusion The SPS demonstrates fair agreement with FPS-R for children and fair-moderate agreement between children and caregivers; agreement improved with repeat use. The SPS is simple and easy to use; it may have a role in empowering direct child and family involvement in pain management.

Concordance Between Electronic Health Record and Tumor Registry Documentation of Smoking Status Among Patients With Cancer

PURPOSE Patients with cancer who use tobacco experience reduced treatment effectiveness, increased risk of recurrence and mortality, and diminished quality of life. Accurate tobacco use documentation for patients with cancer is necessary for appropriate clinical decision making and cancer outcomes research. Our aim was to assess agreement between electronic health record (EHR) smoking status data and cancer registry data. MATERIALS AND METHODS We identified all patients with cancer seen at University of Florida Health from 2015 to 2018. Structured EHR smoking status was compared with the tumor registry smoking status for each patient. Sensitivity, specificity, positive predictive values, negative predictive values, and Kappa statistics were calculated. We used logistic regression to determine if patient characteristics were associated with odds of agreement in smoking status between EHR and registry data. RESULTS We analyzed 11,110 patient records. EHR smoking status was documented for nearly all (98%) patients. Overall kappa (0.78; 95% CI, 0.77 to 0.79) indicated moderate agreement between the registry and EHR. The sensitivity was 0.82 (95% CI, 0.81 to 0.84), and the specificity was 0.97 (95% CI, 0.96 to 0.97). The logistic regression results indicated that agreement was more likely among patients who were older and female and if the EHR documentation occurred closer to the date of cancer diagnosis. CONCLUSION Although documentation of smoking status for patients with cancer is standard practice, we only found moderate agreement between EHR and tumor registry data. Interventions and research using EHR data should prioritize ensuring the validity of smoking status data. Multilevel strategies are needed to achieve consistent and accurate documentation of smoking status in cancer care.

Cultural adaptation and reliability of the ISTAP Skin Tear Classification System to Chilean Spanish

Objective: The International Skin Tear Advisory Panel (ISTAP) created the ISTAP Skin Tear Classification System with the aim of promoting a common and universal language to describe, classify and document skin tears, and increase awareness of the high prevalence of these wounds. Although there is a Spanish version of the ISTAP Skin Tear Classification System, the authors considered it relevant to have a specific Chilean Spanish version. The aim was to achieve the cultural adaptation of the ISTAP Skin Tear Classification System to Chilean Spanish, and verify its content validity and inter-rater reliability. Method: The study consisted of two phases: cultural adaptation of the ISTAP Skin Tear Classification System into Chilean Spanish, and validation of the culturally adapted system. A convenience sample of 150 health professionals classified 30 photographs of skin tears, using the same photographs used in the original ISTAP skin tear classification and validation study. Additionally, the clinical application of the classification system was tested among 20 nurses, who assessed and classified the skin tears (n=24) of hospitalised patients. For analysis of the inter-rater reliability, Fleiss' kappa was used. Results: The differences found in the translation referred to a synonym of the terms ‘skin’ or ‘cutaneous’, and the terms ‘flap’ or ‘tear’. Once analysed and discussed, the term ‘desgarro’ was maintained, which is the translation of the English term ‘flap’. There is no equivalent term for ‘skin tears’ in Spanish, but consensus was reached by researchers and collaborators to use the phrase: ‘desgarro de piel’. Once a consensus was reached on the wording for the translation, back-translation was completed and compared with the original English version and reviewed by the original author of the classification for accuracy. The content validity of the translated version of the ISTAP Skin Tear Classification System into Chilean Spanish showed a moderate agreement for the non-specialised nurses' group (0.4804) and for the specialised nurses' group (0.5308). Inter-rater reliability was achieved by obtaining a moderate agreement (Fleiss' kappa=0.53) and an almost perfect level of agreement for clinical application (Fleiss' kappa=0.83). Conclusion: The reported content validity and inter-rater reliability support the applicability of the cultural adaptation of the ISTAP Skin Tear Classification System to Chilean Spanish into practice.