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A-0792 Interobserver Reliability Study of the Classification of Scaphoid Waist Fractures using Computer-Tomography
Rasmus Wejnold Jørgensen, Anders Klahn, Johannes Heindl, Lars Solgård, Lars Vadstrup, Dejan Susic, Robert Gvozdenovic, Stig Jørring, Claus Hjorth Jensen, Hand Clinic, Department of Orthopedics, Herlev-Gentofte University Hospital of Copenhagen, Denmark
Friday, June 15, 2018 · 2:23 p.m. · 05m 43s
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00:00:00
okay thank you for the introduction
00:00:05
so the background of the study is that we think uh that conventional radio grass are
00:00:10
uh unreliable and insufficient in the classification of skateboard a weight factors
00:00:16
and uh the the choice of treatment uh of these uh uh regress
00:00:21
uh computes marker fee has been playing to be the
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tool of choice when determining factor displacement and uh
00:00:28
fact a displacement this uh maybe one of the most important factor is uh in fact revealing
00:00:35
so the purpose of the study is to determine the inter rater reliability and
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integrated beep visibility in the classification and that the
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choice of treatment in a skip always fractures
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the rate of population uh consisted out of the of the peak surgeons with
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a particular interest in hand surgery they're all working at our department
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so we had fifty one scapegoat way factors with c. t. scans
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and a seven independent of the p. d. surgeons uh they look at all the scans
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they classified each factor in uh on this place fractures list into millimetre displacement or more
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than two millimetre displacement and they suggested the treatment of a four weeks remotely station
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uh maybe a controversial but uh four weeks a mobile station
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eight to twelve weeks mobile station and uh operation
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this could be a simplified just to look at the the factors that was
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a classified less than two millimetre displays the more than two millimetre
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and uh uh the factors that were uh suggested to be treated
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non operative lee or uh with o. production so fixation
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so based on the first round of classification we were able
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to calculate the inter rater reliability meaning how well each
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surgeon agree with each other and uh we did this both for the classification and the choice of treatment
00:01:59
based on the second round classification we uh we
00:02:02
could calculate the integrated reproduce ability meaning how
00:02:06
well each surgeon agreed with themself both for the classification and that the choice of treatment
00:02:13
and uh these uh demographics are base that on the first round of uh
00:02:18
uh both uh classification and and treatment and we see that uh about
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thirty eight percent of the the fractures or classified as on displaced
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forty percent more than or less than a two millimetre displaced
00:02:31
and the twenty percent a modern term limits placed
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for the treatment uh about eighty percent or suggest it should be
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treated conservatively and uh about twenty percent uh uh operate
00:02:45
and so for the inter rater reliability how well the the surgeons
00:02:49
agree with each other uh we calculate the kappa value
00:02:53
and uh the kappa value was interpreted or translated by land dissing cock a distracted agreement
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and uh when you have the the three different uh classification groups and displaced a less than two millimetre all
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more than two minute display structures the kappa value was a point five to translate to moderate agreement
00:03:13
when you simplify the classification system you get an increase in the kappa
00:03:17
value which is expected and it just met a substantial criteria
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uh in choosing the treatment that we saw a a fairly low kappa value
00:03:28
of a point three uh eight uh um translated to just fair agreement
00:03:34
but when a simplifying the the choice of treatment to the casting versus
00:03:39
open adoption some fixation the kappa value increased as we
00:03:42
expected and uh then it's worse moderate agreement
00:03:48
so looking at the incinerator reproduce ability so the looking at
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how well each surgeon agreed with themselves what they said
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one week earlier um we saw substantial agreement on all parameters and
00:04:01
increasing kappa values when simplifying both the classification system nor the choice of treatment
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so in conclusion to this uh that was substantially inter rater reliability when uh in in
00:04:16
classification between last into media displays the fractures and more than two millimetre space lectures
00:04:22
uh but only moderate inter rater reliability when choosing between an operative treatment or operative treatment
00:04:29
the inter rater rip disability was a substantial the agreement on all parameters
00:04:35
uh and uh both both for the classification and the choice of treatment
00:04:40
so in the future we recommend for the training of surgeons before we will introduce the
00:04:45
routine of c. c. both for the classification fractures and and the choice of treatment
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thank you much how
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are there any questions
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well you said you had that i'm surgeons and have you looked at
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different as well so are there you are working right more experience
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but we yeah we we try to look at this uh um there were some surgeons with a lot of experience and
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younger surgeons with less experience and we didn't uh uh like an
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over test for to see if if any of the surgeons
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did better or worse than the other and there were no different the twenty surgeons
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