How reliable and accurate is the AO/OTA comprehensive classification for adult long-bone fractures
The Journal of Trauma and Acute Care Surgery,

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.

Methods
  • 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.

Results
  • 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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