Effect of clinician's experience and expertise on the inter- and intra-observer reliability of the computed tomography-based classification systems in posterior malleolus fractures.

Yiğit Umur Cırdı, Mehmet Demirel, Mahmut Enes Kayaalp, Ramazan İlter Öztürk, Muhammet Bozoğlan, Andrea Giordano Salvi
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Abstract

Three computed tomography (CT)-based classifications, including Haraguchi, Bartoníček-Rammelt, and Mason-Molloy systems, have been developed to better determine the characteristics of posterior malleolus fractures (PMFs). The aims of this study were (1) to determine the intra- and inter-observer reliability of the computed tomography-based classification systems and (2) to investigate the clinical experience and expertise on their reliabilities. Sixty-seven preoperative ankle CT scans of 67 adult patients with "ankle fracture with the involvement of the posterior malleolus"'' were retrospectively identified. CT images were assessed by 10 observers with different levels of clinical experience from 2 different specialties, including orthopedics and radiology. The observers were asked to classify PMFs according to 3 CT-based classifications on 2 separate occasions with a 4-week interval. Cohen's κ values were measured for 2 raters and Fleiss' κ values were measured for 3 raters and more. Overall, each classification had moderate to very good intraobserver reliability (κ=0.41 to 0.95, P < .01) as well as moderate interobserver reliability for each of the 2 separate assessments (κ=0.41 to 0.60, P < .01 for the first occasion; κ=0.44 to 0.59, P < .01 for the second occasion). Interobserver agreement among the foot and ankle surgeons regarding the Haraguchi and Bartoníček classifications was substantial for both assessment periods, whereas there was a moderate agreement for the Mason classification. Orthopedic residents showed moderate interobserver agreement in each period for both Bartoníček and Mason classifications. Radiology experts illustrated slight and fair agreements in the 2 assessments for Mason classification, moderate agreement in both assessments for Haraguchi classification, and substantial to moderate agreement in the first and second assessments for Bartoníček classification, respectively. Computed tomography-based classification system for PMFs demonstrated moderate interobserver reliability as well as moderate to very good intraobserver reliability. Moreover, foot and ankle specialists exhibit enhanced K values for both inter and intraobserver reliability for each classification system, consistency seems to increase as the interest in the field condenses.

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临床医生的经验和专业知识对基于计算机断层扫描的后踝骨骨折分类系统的观察者间和观察者内可靠性的影响。
目前已开发出三种基于计算机断层扫描(CT)的分类系统,包括 Haraguchi 系统、Bartoníček-Rammelt 系统和 Mason-Molloy 系统,以更好地确定踝后骨折(PMF)的特征。本研究的目的是:(1)确定基于计算机断层扫描的分类系统在观察者内部和观察者之间的可靠性;(2)研究临床经验和专业知识对其可靠性的影响。本研究回顾性地确定了 67 名 "踝关节骨折累及后踝骨"''成年患者的 67 张术前踝关节 CT 扫描图像。来自骨科和放射科等两个不同专业、具有不同临床经验的 10 名观察员对 CT 图像进行了评估。观察者被要求根据 3 种基于 CT 的分类方法对 PMF 进行分类,每次间隔 4 周。测量了2名评分者的Cohen's κ值和3名及以上评分者的Fleiss's κ值。总体而言,每种分类的观察者内部可靠性为中等至非常好(κ=0.41 至 0.95,P < .01),观察者之间的可靠性为中等(第一次κ=0.41 至 0.60,P < .01;第二次κ=0.44 至 0.59,P < .01)。在两次评估中,足踝外科医生对 Haraguchi 和 Bartoníček 分类的观察者之间的一致性都很高,而对 Mason 分类的观察者之间的一致性则处于中等水平。骨科住院医师在每个阶段对巴顿切克和梅森分类的观察者间一致性均为中等。放射科专家在梅森分类的两次评估中显示出轻微和一般的一致性,在原口分类的两次评估中显示出中等程度的一致性,在巴顿切克分类的第一次和第二次评估中分别显示出实质性和中等程度的一致性。基于计算机断层扫描的 PMF 分类系统显示出中等程度的观察者间可靠性以及中等至非常好的观察者内可靠性。此外,足踝专科医生在每种分类系统的观察者间和观察者内可靠性方面都表现出更高的K值,随着对该领域兴趣的增加,一致性似乎也在增加。
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