OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5–10 years, 10–20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson’s chi-square or Fisher’s exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5–10 years: 0.69 vs 10–20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5–10 years: 0.62 vs 10–20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5–10 years: 0.61 vs 10–20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system.
Effect of surgical experience and spine subspecialty on the reliability of the {AO} Spine Upper Cervical Injury Classification System / Lambrechts, Mark J.; Schroeder, Gregory D.; Karamian, Brian A.; Canseco, Jose A.; Cumhur Oner, F.; Benneker, Lorin M.; Bransford, Richard J.; Frank, Kandziora; Shanmuganathan, Rajasekaran; Mohammad, El-Sharkawi; Rishi, Kanna; Andrei Fernandes Joaquim, ; Klaus, Schnake; Kepler, Christopher K.; Vaccaro (_) (_) (_) (_), Alexander R.; Dewan, Asif; Sachin, Borkar; Joseph, Bakar; Slavisa, Zagorac; Welege, Wimalachandra; Oleksandr, Garashchuk; Francisco, Verdu-Lopez; Giorgio, Lofrese; Pragnesh, Bhatt; Oke, Obadaseraye; Axel, Partenheimer; Marion, Riehle; Eugen Cesar Popescu, ; Christian, Konrads; Nur Aida Faruk Senan, ; Adetunji, Toluse; Nuno, Neves; Takahiro, Sunami; Bart, Kuipers; Jayakumar, Subbiah; Anas, Dyab; Peter, Loughenbury; Derek, Cawley; Ren('(e)), Schmidt; Loya, Kumar; Farhan, Karim; Zacharia, Silk; Michele, Parolin; Hisco, Robijn; Kalbani, Al; Ricky, Rasschaert; Christian, Müller; Marc, Nieuwenhuijse; Selim, Ayhan; Shay, Menachem; Sarvdeep, Dhatt; Nasser, Khan; Subramaniam, Haribabu; Moses, Kimani; Olger, Alarcon; Nnaemeka, Alor; Dinesh, Iyer; Michal, Ziga; Konstantinos, Gousias; Gisela, Murray; Michel, Triffaux; Sebastian, Hartmann; Sung-Joo, Yuh; Siegmund, Lang; Kyaw, Linn; Charanjit Singh Dhillon, ; Waeel, Hamouda; Stefano, Carnesecchi; Vishal, Kumar; Lady Lozano Cari, ; Gyanendra, Shah; Furuya, Takeo; Federico, Sartor; Fernando, Gonzalez; Hitesh, Dabasia; Wongthawat, Liawrungrueang; Lincoln, Liu; Younes El Moudni, ; Ratko, Yurak; H('(e))ctor, Aceituno; Madhivanan, Karthigeyan; Andreas, Demetriades; Sathish, Muthu; Matti, Scholz; Wael, Alsammak; Komal, Chandrachari; Khoh Phaik Shan, ; Trungu, Sokol; Joost, Dejaegher; Omar, Marroquin; Moisa Horatiu Alexandru, ; M('(a))ximo-Alberto, Diez-Ulloa; Paulo, Pereira; Claudio, Bernucci; Christian, Hohaus; Miltiadis, Georgiopoulos; Annika, Heuer; Ahmed Arieff Atan, ; Mark, Murerwa; Richard, Lindtner; Manjul, Tripathi; Huynh Hieu Kim, ; Ahmed, Hassan; Norah, Foster; Amanda, O'Halloran; Koroush, Kabir; Mario, Ganau; Daniel, Cruz; Amin, Henine; Jeronimo, Milano; Abeid, Mbarak; Arnaldo, Sousa; Satyashiva, Munjal; Mahmoud, Alkharsawi; Muhammad, Mirza; Parmenion, Tsitsopoulos; Fon-Yih, Tsuang; Oliver, Risenbeck; Arun-Kumar, Viswanadha; Samer, Samy; David, Orosco; Gerardo, Zambito-Brondo; Nauman, Chaudhry; Luis, Marquez; Jacob, Lepard; Juan, Mu(~(n))oz; Stipe, Corluka; Soh, Reuben; Ariel, Kaen; Nishanth, Ampar; Sebastien, Bigdon; Dami('(a))n, Caba; Francisco De Miranda, ; Loren, Lay; Ivan, Marintschev; Mohammed, Imran; Sandeep, Mohindra; Naga Raju Reddycherla, ; Pedro, Baz('(a))n; Abduljabbar, Alhammoud; Iain, Feeley; Konstantinos, Margetis; Alexander, Durst; Ashok Kumar Jani, ; Rian Souza Vieira, ; Felipe, Santos; Joshua, Karlin; Nicola, Montemurro; Sergey, Mlyavykh; Brian, Sonkwe; Darko, Perovic; Juan, Lourido; Ramieri, Alessandro; Eduardo, Laos; Uri, Hadesberg; Andrei-Stefan, Iencean; Neves de Carvalho, Pedro; Eduardo, Bertolini; Naresh, Kumar; Philippe, Bancel; Bishnu, Sharma; John, Koerner; Eloy Rusafa Neto, ; Nima, Ostadrahimi; Olga, Morillo; Kumar, Rakesh; Andreas, Morakis; Amauri, Godinho; Keerthivasan, P.; Richard, Menger; Louis, Carius; Rajesh Bahadur Lakhey, ; Ehab, Shiban; Vishal, Borse; Elizabeth, Boudreau; Gabriel, Lacerda; Paterakis, Konstantinos; Mubder Mohammed Saeed, ; Toivo, Hasheela; Susana N('(u))(~(n))ez Pereira, ; Jay, Reidler; Nimrod, Rahamimov; Mikolaj, Zimny; Devi Prakash Tokala, ; Hossein, Elgafy; Ketan, Badani; Bing Wui Ng, ; Cesar Sosa Juarez, ; Thomas, Repantis; Ignacio, Fern('(a))ndez-Bances; John, Kleimeyer; Nicolas, Lauper; Luis Mar('(i))a Romero-Mu(~(n))oz, ; Ayodeji, Yusuf; Zdenek, Klez; John, Afolayan; Joost, Rutges; Alon, Grundshtein; Rafal, Zaluski; Stavridis, Stavros I.; Takeshi, Aoyama; Petr, Vachata; Wiktor, Urbanski; Martin, Tejeda; Luis, Mu(~(n))iz; Susan, Karanja; Antonio, Mart('(i))n-Benlloch; Heiller, Torres; Chee-Huan, Pan; Luis, Duch('(e))n; Yuki, Fujioka; Meric, Enercan; Mauro, Pluderi; Catalin, Majer; Vijay, Kamath. - In: JOURNAL OF NEUROSURGERY. SPINE. - ISSN 1547-5654. - (2022), pp. 1-11. [10.3171/2022.6.spine22454]
Effect of surgical experience and spine subspecialty on the reliability of the {AO} Spine Upper Cervical Injury Classification System
Sokol Trungu;Mohammed Imran;Alessandro Ramieri;Pedro Neves;Naresh Kumar;
2022
Abstract
OBJECTIVE The objective of this paper was to determine the interobserver reliability and intraobserver reproducibility of the AO Spine Upper Cervical Injury Classification System based on surgeon experience (< 5 years, 5–10 years, 10–20 years, and > 20 years) and surgical subspecialty (orthopedic spine surgery, neurosurgery, and "other" surgery). METHODS A total of 11,601 assessments of upper cervical spine injuries were evaluated based on the AO Spine Upper Cervical Injury Classification System. Reliability and reproducibility scores were obtained twice, with a 3-week time interval. Descriptive statistics were utilized to examine the percentage of accurately classified injuries, and Pearson’s chi-square or Fisher’s exact test was used to screen for potentially relevant differences between study participants. Kappa coefficients (κ) determined the interobserver reliability and intraobserver reproducibility. RESULTS The intraobserver reproducibility was substantial for surgeon experience level (< 5 years: 0.74 vs 5–10 years: 0.69 vs 10–20 years: 0.69 vs > 20 years: 0.70) and surgical subspecialty (orthopedic spine: 0.71 vs neurosurgery: 0.69 vs other: 0.68). Furthermore, the interobserver reliability was substantial for all surgical experience groups on assessment 1 (< 5 years: 0.67 vs 5–10 years: 0.62 vs 10–20 years: 0.61 vs > 20 years: 0.62), and only surgeons with > 20 years of experience did not have substantial reliability on assessment 2 (< 5 years: 0.62 vs 5–10 years: 0.61 vs 10–20 years: 0.61 vs > 20 years: 0.59). Orthopedic spine surgeons and neurosurgeons had substantial intraobserver reproducibility on both assessment 1 (0.64 vs 0.63) and assessment 2 (0.62 vs 0.63), while other surgeons had moderate reliability on assessment 1 (0.43) and fair reliability on assessment 2 (0.36). CONCLUSIONS The international reliability and reproducibility scores for the AO Spine Upper Cervical Injury Classification System demonstrated substantial intraobserver reproducibility and interobserver reliability regardless of surgical experience and spine subspecialty. These results support the global application of this classification system.| File | Dimensione | Formato | |
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