Inter-observer and intra-observer agreement of cervical vertebral maturation staging: A systematic review and meta-analysis

IF 1.8 Q2 DENTISTRY, ORAL SURGERY & MEDICINE International Orthodontics Pub Date : 2024-04-25 DOI:10.1016/j.ortho.2024.100874

Umar Hussain , Faizan Ul Hassan , Muhammad Abdullah Kamran , Abdullah A. Alnazeh , Imran Ullah , Shamsul Alam

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Abstract

Introduction

The accurate assessment of active growth is pivotal for the correction of skeletal malocclusion in growing patients. Cervical vertebral maturation (CVM) staging is easy and devoid of unnecessary radiation, but its inter- and intra-observer agreement is still debatable.

Objective

This study aims to assess inter-observer (reliability) and intra-observer agreement (reproducibility) for CVM staging.

Methods

A comprehensive literature search across five databases up to October 2023 was conducted. Inclusion criteria comprised observational studies that specifically reported intra-rater, inter-rater, or both agreements as their primary objectives for cervical vertebral maturation (CVM) staging. Studies with a sample size exceeding 15 participants were considered for inclusion. After duplicate study selection, data extraction, and risk-of-bias assessment, random-effects meta-analyses of kappa (k)/correlation coefficient (r) and their 95% confidence intervals (CIs) were performed, followed by meta-regressions, sensitivity analyses, and subgroup analyses.

Results

Seventeen observational studies (comprising 1437 lateral cephalograms and 110 assessors) were included. The reliability (8 studies; k = 0.62 [95% CI: 0.44, 0.78]) and reproducibility (9 studies; k = 0.708 [95% CI: 0.59, 0.82]) were substantial. The inter-observer correlation was almost perfect (in 9 studies; r = 0.86 [95% CI: 0.82, 0.89]) while intra-observer correlation was substantial (in 2 studies; r = 0.75 [95% CI: 0.62, 0.84]). Tracing of lateral cephalograms significantly increased inter-observer reliability (β = 0.29 [0.57, 0.0031]) but cropping and time of assessment (initial vs. follow-up) had no significant impact. The reliability (P < 0.001) and reproducibility (P = 0.049) of high-quality studies were superior to those observed in low-quality studies.

Conclusion

Assessment of the CVM staging is accurate and reproducible to a satisfactory level. The accuracy and reproducibility of CVM are higher in studies utilizing traced cephalograms and those with a low-risk of bias.

Registration

PROSPERO registration (CRD42023468521).

Data is openly available at https://doi.org/10.5281/zenodo.10599129.

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颈椎成熟分期的观察者间和观察者内一致性：系统回顾和荟萃分析

引言准确评估主动生长对于矫正生长期患者的骨骼错合畸形至关重要。本研究旨在评估颈椎成熟（CVM）分期的观察者间（可靠性）和观察者内（再现性）一致性。方法对截至 2023 年 10 月的五个数据库进行了全面的文献检索。纳入标准包括将观察者内部、观察者之间或两者的一致性作为颈椎成熟度（CVM）分期的主要目标的观察性研究。样本量超过 15 人的研究也在考虑之列。在进行了重复研究选择、数据提取和偏倚风险评估后，对卡帕（k）/相关系数（r）及其 95% 置信区间（CI）进行了随机效应荟萃分析，随后进行了荟萃回归、敏感性分析和亚组分析。可靠性（8 项研究；k = 0.62 [95% CI：0.44, 0.78]）和再现性（9 项研究；k = 0.708 [95% CI：0.59, 0.82]）都很高。观察者之间的相关性几乎完美（9 项研究；r = 0.86 [95% CI：0.82, 0.89]），而观察者内部的相关性很高（2 项研究；r = 0.75 [95% CI：0.62, 0.84]）。侧位头颅影像描记可显著提高观察者间的可靠性（β = 0.29 [0.57, 0.0031]），但裁剪和评估时间（初次评估与随访）没有显著影响。高质量研究的可靠性（P < 0.001）和可重复性（P = 0.049）优于低质量研究。使用描记头像图和偏倚风险低的研究中，CVM 的准确性和可重复性更高。注册PROSPERO 注册（CRD42023468521）。数据可在 https://doi.org/10.5281/zenodo.10599129 公开获取。

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来源期刊

International Orthodontics DENTISTRY, ORAL SURGERY & MEDICINE-

CiteScore

2.50

自引率

13.30%

发文量

审稿时长

26 days

期刊介绍： Une revue de référence dans le domaine de orthodontie et des disciplines frontières Your reference in dentofacial orthopedics International Orthodontics adresse aux orthodontistes, aux dentistes, aux stomatologistes, aux chirurgiens maxillo-faciaux et aux plasticiens de la face, ainsi quà leurs assistant(e)s. International Orthodontics is addressed to orthodontists, dentists, stomatologists, maxillofacial surgeons and facial plastic surgeons, as well as their assistants.