The AO comprehensive classification of pediatric long-bone fractures: a web-based multicenter agreement study.

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State: Public
Version: Final published version
Serval ID
serval:BIB_691D3817D9C5
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
The AO comprehensive classification of pediatric long-bone fractures: a web-based multicenter agreement study.
Journal
Journal of Pediatric Orthopedics
Author(s)
Slongo T., Audigé L., Clavert J.M., Lutz N., Frick S., Hunter J.
ISSN
0271-6798 (Print)
ISSN-L
0271-6798
Publication state
Published
Issued date
2007
Peer-reviewed
Oui
Volume
27
Number
2
Pages
171-180
Language
english
Notes
Publication types: Journal Article ; Multicenter StudyPublication Status: ppublish
Abstract
The first AO comprehensive pediatric long-bone fracture classification system has been proposed following a structured path of development and validation with experienced pediatric surgeons. A Web-based multicenter agreement study involving 70 surgeons in 15 clinics and 5 countries was conducted to assess the reliability and accuracy of this classification when used by a wide range of surgeons with various levels of experience. Training was provided at each clinic before the session. Using the Internet, participants could log in at any time and classify 275 supracondylar, radius, and tibia fractures at their own pace. The fracture diagnosis was made following the hierarchy of the classification system using both clinical terminology and codes. kappa coefficients for the single-surgeon diagnosis of epiphyseal, metaphyseal, or diaphyseal fracture type were 0.66, 0.80, and 0.91, respectively. Median accuracy estimates for each bone and type were all greater than 80%. Depending on their experience and specialization, surgeons greatly varied in their ability to classify fractures. Pediatric training and at least 2 years of experience were associated with significant improvement in reliability and accuracy. Kappa coefficients for diagnosis of specific child patterns were 0.51, 0.63, and 0.48 for epiphyseal, metaphyseal, and diaphyseal fractures, respectively. Identified reasons for coding discrepancies were related to different understandings of terminology and definitions, as well as poor quality radiographic images. Results supported some minor adjustments in the coding of fracture type and child patterns. This classification system received wide acceptance and support among the surgeons involved. As long as appropriate training could be performed, the system classification was reliable, especially among surgeons with a minimum of 2 years of clinical experience. We encourage broad-based consultation between surgeons' international societies and the use of this classification system in the context of clinical practice as well as prospectively for clinical studies.
Keywords
Child, Fibula/injuries, Fractures, Bone/classification, Humans, Humeral Fractures/classification, Internet, Orthopedics, Prospective Studies, Radius Fractures/classification, Tibial Fractures/classification, Ulna Fractures/classification
Pubmed
Web of science
Create date
20/01/2013 16:19
Last modification date
20/08/2019 15:24
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