How reliable and accurate is the AO/OTA comprehensive classification for adult long-bone fractures
The Journal of Trauma and Acute Care Surgery, 05/04/2012
Meling T et al. – Both the reliability and accuracy of the comprehensive Arbeitsgemeinschaft fur Osteosynthesefragen/Orthopedic Trauma Association classification for long–bone fractures ranged from substantial to excellent. Variations in coding accuracy seem to be related more to the fracture itself than the surgeon.
Adults (>16years) with long-bone fractures coded in a Fracture and Dislocation Registry at the Stavanger University Hospital during the fiscal year 2008 were included.
An unblinded reference code dataset was generated for the overall accuracy assessment by two experienced orthopedic trauma surgeons.
Blinded analysis of intrarater reliability was performed by rescoring and of interrater reliability by recoding of a randomly selected fracture sample.
Proportion of agreement (PA) and kappa ([kappa]) statistics are presented.
Uni- and multivariate logistic regression analyses of factors predicting accuracy were performed.
During the study period, 949 fractures were included and coded by 26 surgeons.
For the intrarater analysis, overall agreements were [kappa]=0.67 (95% confidence interval [CI]: 0.64-0.70) and PA 69%.
For interrater assessment, [kappa]=0.67 (95% CI: 0.62-0.72) and PA 69%.
The accuracy of surgeons' blinded recoding was [kappa]=0.68 (95% CI: 0.65-0.71) and PA 68%.
Fracture type, frequency of the fracture, and segment fractured significantly influenced accuracy whereas the coder's experience did not.
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