Clasificacion de lesiones meniscales de ISAKOS: estudio de reproducibilidad intra e interobservador / Intra and interobserver reliability of ISAKOS classification for meniscal tears

Introducción: El objetivo de este trabajo fue analizar la reproducibilidad intra e interobservador de la clasificación de lesiones meniscales de Sociedad Internacional de Artroscopía, Cirugía de la Rodilla y Medicina Deportiva (ISAKOS). Materiales y Métodos: Se utilizó la clasificación artroscópica de lesiones meniscales creada por la ISAKOS. Se seleccionaron y se analizaron 31 videos artroscópicos de cirugías realizadas en el Hospital Italiano de Buenos Aires. Los mismos fueron evaluados por 3 traumatólogos (2 especialistas en cirugía de rodilla y un becario de postgrado), en dos ocasiones con un intervalo de 30 días. Se utilizó el índice de Kappa de Cohen para evaluar la reproducibilidad intraobservador y el coeficiente de correlación intraclase para la reproducibilidad interobservador. Resultados: La reproductibilidad promedio intraobservador fue para el primero de 51%, para el segundo de 65% y para el tercero de 58%, alcanzando un acuerdo moderado según la categorización del coeficiente de Kappa utilizada por Landis y Koch. Con respecto a la reproductibilidad interobservador, se obtuvo una concordancia buena (ICC=0,71), según el Coeficiente de correlación intraclase. Todos los cálculos fueron estadisticamente significativos. (p<0,05). Conclusión: Si bien esta clasificación permite una detallada descripción de las lesiones meniscales, la reproductibilidad intraobservador no alcanzo los valores óptimos a pesar de haber obtenido en promedio un acuerdo moderado. Por otro lado, la reproductibilidad interobservador demostró en promedio resultados mayores al 70% (concordancia buena), con lo cual podemos afirmar que el acuerdo y reproductibilidad interobservador es aceptable. Tipo de trabajo: Observacional, descriptivo de tipo diagnóstico. Nivel de Evidencia: IV

Objectives: To analyze the intra and interobserver reliability of the International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS) classification for meniscal tears. Methods: The arthroscopic classification for meniscal lesions created by the ISAKOS was used. Thirty-one arthroscopic videos with different meniscal tear characteristics were analyzed by three orthopedic surgeons (two specialists in knee surgery and a fellow), twice at an interval of 30 days. The Kappa Coefficients (k) was used to assess the intraobserver reliability and intraclass correlation coefficient (ICC) for interobserver reliability. Results: The average intraobserver reliability was 51% for the first observer, 65% for the second and 58% for the third, reaching moderate agreement according to the Kappa coefficient used by Landis and Koch. Regarding interobserver reliability, good agreement (ICC = 0.71) was obtained for the intraclass correlation coefficient. The whole results were statistically significant (p <0.05). Conclusion: While this classification provides a detailed description of meniscal lesions, the intraobserver reliability did not reach the optimum values obtained despite having on average a moderate agreement. However interobserver reliability showed on average agreement of 70% (good agreement), which can affirm that the agreement and interobserver reliability is acceptable. Type of Study: Observational, descriptive, a diagnostic study. Level Of Evidence: IV

Ultrasonographic Measurements of the Intramuscular Fluid Collection Using a Phantom: A Preliminary Study / 대한정형외과학회잡지

PURPOSE: The purpose of this study is to check the intermuscular fluid collection in a phantom using ultrasound after comparison with the original injected volume of gel and to evaluate interobserver reliability. MATERIALS AND METHODS: One orthopedic surgeon injected ultrasonographic gel into the muscle of slaughtered cow meat using a syringe and needle, and recorded the injected volume. The injected volume of gel ranged from 1 ml to 5 ml, and total number of trials was 30 times. The volume was calculated using ultrasound by two experienced radiologists. The ultrasonographic measured volme was assessed and interobserver variability was measured. RESULTS: The mean ultrasonographic measured volume was 71.35% of the original injected volume of gel. Thus, the measured volume using ultrasound showed a tendency to underestimate the injected volume into the muscle. For evaluation of interobserver reliability, interclass correlation using SPSS and consistency using Bland and Altman plot were calculated. Interclass correlation was 0.95, and Bland and Altman plot showed that the differences of mean volume measured by two observers were within ±1.96 standard deviation over 95%. Therefore, it showed good interoberver reliability. CONCLUSION: Ultrasonographic measurement of the intramuscular fluid collection in a phantom showed mean 71.35% of the original injected volume of gel, and it tended to be underestimated in proportion to the increased volume of intermuscular gel. This study showed good interobserver reliability.

Confiabilidade interobservador da classificação internacional de atenção primária em uma unidade de atenção básica à saúde / Interobserver reliability of the international classification of primary care at a primary health care unit

Avaliou-se a confiabilidade interobservador da Classificação Internacional de Atenção Primária na codificação de queixas relatadas em unidade básica de saúde pública, por meio de uma amostra de 300 atendimentos. Os motivos de consulta foram registrados por médicos do serviço, e sua codificação realizada por duas pesquisadoras. A concordância entre as classificadoras em relação ao número de motivos codificados foi calculada por meio do kappa ponderado; para as demais análises (capítulos e códigos completos), foi utilizado o coeficiente kappa simples. Foram codificados 634 motivos pela primeira classificadora e 699 pela segunda. A concordância simples do número de motivos foi moderada, com kappa ponderado de 0,71 (Intervalo de 95% de Confiança [IC95%]: 0,68-0,73). Em relação aos códigos de capítulos e códigos completos, foram encontradas confiabilidade substancial (kappa = 0,89; IC95%: 0,87-0,91) e moderada (kappa = 0,72; IC95%: 0,68-0,76), respectivamente. Os resultados indicam bom desempenho da classificação para codificar motivos de atendimento na atenção básica, mesmo a partir de registros médicos.

We evaluated the International Classification of Primary Care interobserver reliability for coding the complaints reported at a primary public health unit. The study sample consisted of 300 appointments. Reasons for appointment were registered by physicians on the medical record and coding was performed by two investigators. Reliability among the classifiers as to the number of coded reasons was calculated by weighted kappa. Crude kappa coefficients were used for the remaining analyses (chapter codes and full codes). A total of 634 reasons were coded by the first classifier and 699 by the second one. Crude reliability of numbers of reasons was moderate, with a 0.71 weighted kappa (95% Confidence Interval [95%CI]: 0.68-0.73). Regarding chapter codes and full codes, reliability was substantial (kappa = 0.89; 95%CI: 0.87-0.91) and moderate (kappa = 0.72; 95% CI: 0.68-0.76), respectively. Our results suggest a good performance of the Classification for coding reasons for visit in primary care, even when data are obtained from physician consultation notes.

The New Radiographic Evaluation of Hindfoot Alignment / 대한족부족관절학회지

PURPOSE: There are various methods proposed for the evaluation of the hindfoot alignment. However, due to structural calcaneus variances between patients, it is hard to assess this alignment definitively. Thus, this study proposes a new method for evaluating of the hindfoot alignment and its comparisons to the existing current methods. MATERIALS AND METHODS: This study includes simple weight bearing hindfoot coronal view radiographs of 120 patients, taken between the time period of March 2008 to November 2009. Among the 120 patients, there was a 1:1 ratio of male to female with an average age of 40. The newly proposed method for evaluating this alignment is to draw a moment arm from the point where the sustentaculum tali meets the medial calcaneus border to the most prominent aspect of the lateral process of the calcaneal tuberosity. The angle produced via the intersection of this moment arm to the mid-longitudinal axis of the tibia is found and used to evaluate the hindfoot alignment. The inter and intra-observer reliability was evaluated using the coefficient of intraclass correlation. This study also investigates the comparisons between the newly proposed method to the traditionally used Saltzman et al hindfoot alignment evaluating technique. RESULTS: The newly proposed method has higher inter and intra-observer reliability than the existing traditional Saltzman et al technique. CONCLUSION: This new method is recommended over the traditionally used Saltzman et al technique as it has a stronger confidence level and is appropriate for assessing hindfoot alignment in simple radiographs.

Intra-and interobserver reliability of analysis of lower limb alignment on digital images using AutoCAD / 中国基层医药

Objective To evaluate intra-and interobserver reliability of analysis of lower limb alignment on DR digital images using AutoCAD.Methods Angles on AP view and long leg view were measured three times by two trained observers separately using these two methods in 140 knees.The intra-and interobserver intraclass correlation coefficients with 95% CIs of two methods were calculated and compared with Fisher z transformation and Z test.Paired t test was used in comparing time consumption.Results For AutoCAD method,inter ICCs were 0.942? 0.993 ,intra ICCs were 0.937～0.999.For X-ray films method,inter ICCs were 0.736～0.981,intra ICCs were 0.759～0.951.Corresponding ICCs of AutoCAD method were higher than those of X-ray films method,most of which had significant differences(P<0.01).The consuming time of two observers in measuring one knee using AutoCAD method was 89.6 seconds and 94.3 seconds shorter than those using X-ray films method respectively.Both had significant differences(P<0.01).Conclusion It was a fast reliable method to assess lower limb alignment on DR digital images using AutoCAD.

An analysis of adolescent idiopathic scoliosis according to Coonrad classification / 대한정형외과학회잡지

PURPOSE: To establish the interobserver and intraobserver reliability of the Coonrad classification for an idiopathic coronal curve pattern. MATERIALS AND METHODS: Radiographs of 257 idiopathic scoliosis patients that had a rib humping of more than 1 cm and a Cobb angle of more than 10 were reviewed. The interobserver and intraobserver reliability was assessed by a comparison of the classification of the curves between four observers. RESULTS: In the Coonrad classification, a 1A type-curve occurred in 37 cases, the 1B type-curve occurred in 27 cases, the 2A type-curve occurred in 70 cases, a 2B type-curve occurred in 22 cases, a 3 type-curve occurred in 44 cases, a 4 type-curve occurred in 6 cases, a 5 type-curve occurred in 15 cases, a 6 type-curve occurred in 22 cases, a 7 type-curve occurred in 13 cases and a 8 type curve occurre in 1 case. The interobserver reliability for the Coonrad classification was 0.60 and the intraobserver reliability was 0.71. CONCLUSION: The Coonrad classification proved to be relatively reliable, but revealed some confusion, particularly between type 2A and type 3. Also, there seemed to be no advantage in using this method of determining the treatment modality compared with the conventional scoliosis classification system.

Clinical Value of Supraspinatus Outlet View and Thirty-Degree Caudal Tilt View in Rotator Cuff Disease / 대한정형외과학회잡지

Supraspinatus outlet view and thirty-degree caudal tilt view have been used for the diagnosis of rotator cuff disease. Because scapula is moving on the thoracic cage, these two views are not always easy to take. The purposes of this study were to investigate the detectability of these views, to compare both views and to observe the interobserver reliability of these views. Supraspinatus outlet views and thirty-degree caudal tilt views were taken from 66 shoulders with clinically diagnosed rotator cuff disease. The shape of the acromions was examined on the supraspinatus outlet views and the size and shape of the acromions were analyzed on the thirty-degree caudal tilt views. An orthopaedic resident, an orthopaedic staff and a radiologic staff reviewed the all films without knowing the opinions of others. Suprapinatus outlet views were not-acceptable in average 43.9% and thirty-degree caudal tilt view were not-acceptable in average 12.6%. All of the three observes had same opinions in 43.9% for the supraspinatus outlet views, and in 45.5% for in thirty-degree caudal tilt views. Disagreement among all three observes was noticed in 13.6% for the supraspinatus outlet views and in 3.0% for in thirty-degree caudal tilt views. In the supraspinatus outlet views, the hooked acromions appeared in average 12.1%. In the thirty-degree caudal tilt view, acromial spurs appeared in average 27.3%. Only 2.5% in average showed hooked acromion on supraspinatus outlet view and acromial spur on thirty-degree caudal tilt view. Thirty-degree caudal tilt view is easier to take and more reliable than supraspinatus outlet view. In is better to take both supraspinatus outlet view and thirty-degree caudal tilt view for each patients with rotator cuff diseases. Radiologic findings should be judged on the base of clinical feature.