Reliability and reproducibility of subaxial cervical injury description system: a standardized nomenclature schema.

dc.contributor.author

Bono, Christopher M

dc.contributor.author

Schoenfeld, Andrew

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Gupta, Giri

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Harrop, James S

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Anderson, Paul

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Patel, Alpesh A

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Dimar, John

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Aarabi, Bizhan

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Dailey, Andrew

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Vaccaro, Alexander R

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Gahr, Ralf

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Shaffrey, Christopher

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Anderson, David G

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Rampersaud, Raj

dc.date.accessioned

2023-10-11T18:18:12Z

dc.date.available

2023-10-11T18:18:12Z

dc.date.issued

2011-08

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2023-10-11T18:18:12Z

dc.description.abstract

Study design

Radiographic measurement study.

Objective

To develop a standardized cervical injury nomenclature system to facilitate description, communication, and classification among health care providers. The reliability and reproducibility of this system was then examined.

Summary of background data

Description of subaxial cervical injuries is critical for treatment decision making and comparing scientific reports of outcomes. Despite a number of available classification systems, surgeons, and researchers continue to use descriptive nomenclature, such as "burst" and "teardrop" fractures, to describe injuries. However, there is considerable inconsistency with use of such terms in the literature.

Methods

Eleven distinct injury types and associated definitions were established for the subaxial cervical spine and subsequently refined by members of the Spine Trauma Study Group. A series of 18 cases of patients with a broad spectrum of subaxial cervical spine injuries was prepared and distributed to surgeon raters. Each rater was provided with the full nomenclature document and asked to select primary and secondary injury types for each case. After receipt of the raters' first round of classifications, the cases were resorted and returned to the raters for a second round of review. Interrater and intrarater reliabilities were calculated as percent agreement and Cohen kappa (κ) values. Intrarater reliability was assessed by comparing a given rater's diagnosis from the first and second rounds.

Results

Nineteen surgeons completed the first and second rounds of the study. Overall, the system demonstrated 56.4% interrater agreement and 72.8% intrarater agreement. Overall, interrater κ values demonstrated moderate agreement while intrarater κ values showed substantial agreement. Analyzed by injury types, only four (burst fractures, lateral mass fractures, flexion teardrop fractures, and anterior distraction injuries) demonstrated greater than 50% interrater agreement.

Conclusion

This study demonstrated that, even in ideal circumstances, there is only moderate agreement among raters regarding cervical injury nomenclature. It is hoped that more familiarity with the proposed system will increase reproducibility in the future. Additional research is required to establish the clinical utility of this novel nomenclature schema.
dc.identifier.issn

0362-2436

dc.identifier.issn

1528-1159

dc.identifier.uri

https://hdl.handle.net/10161/29232

dc.language

eng

dc.publisher

Ovid Technologies (Wolters Kluwer Health)

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Spine

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10.1097/brs.0b013e318221a56d

dc.subject

Cervical Vertebrae

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Humans

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Spinal Fractures

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Orthopedic Procedures

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Reproducibility of Results

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Physicians

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Terminology as Topic

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Axis, Cervical Vertebra

dc.title

Reliability and reproducibility of subaxial cervical injury description system: a standardized nomenclature schema.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher|0000-0001-9760-8386

pubs.begin-page

E1140

pubs.end-page

E1144

pubs.issue

17

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

36

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