Description and Reliability of the AOSpine Sacral Classification System.
Publication/Presentation Date
8-19-2020
Abstract
BACKGROUND: Several classification systems exist for sacral fractures; however, these systems are primarily descriptive, are not uniformly used, have not been validated, and have not been associated with a treatment algorithm or prognosis. The goal of the present study was to demonstrate the reliability of the AOSpine Sacral Classification System among a group of international spine and trauma surgeons.
METHODS: A total of 38 sacral fractures were reviewed independently by 18 surgeons selected from an expert panel of AOSpine and AOTrauma members. Each case was graded by each surgeon on 2 separate occasions, 4 weeks apart. Intrarater reproducibility and interrater agreement were analyzed with use of the kappa statistic (κ) for fracture severity (i.e., A, B, and C) and fracture subtype (e.g., A1, A2, and A3).
RESULTS: Seventeen reviewers were included in the final analysis, and a total of 1,292 assessments were performed (646 assessments performed twice). Overall intrarater reproducibility was excellent (κ = 0.83) for fracture severity and substantial (κ = 0.71) for all fracture subtypes. When comparing fracture severity, overall interrater agreement was substantial (κ = 0.75), with the highest agreement for type-A fractures (κ = 0.95) and the lowest for type-C fractures (κ = 0.70). Overall interrater agreement was moderate (κ = 0.58) when comparing fracture subtype, with the highest agreement seen for A2 subtypes (κ = 0.81) and the lowest for A1 subtypes (κ = 0.20).
CONCLUSIONS: To our knowledge, the present study is the first to describe the reliability of the AOSpine Sacral Classification System among a worldwide group of expert spine and trauma surgeons, with substantial to excellent intrarater reproducibility and moderate to substantial interrater agreement for the majority of fracture subtypes. These results suggest that this classification system can be reliably applied to sacral injuries, providing an important step toward standardization of treatment.
Volume
102
Issue
16
First Page
1454
Last Page
1463
ISSN
1535-1386
Published In/Presented At
Vaccaro, A. R., Schroeder, G. D., Divi, S. N., Kepler, C. K., Kleweno, C. P., Krieg, J. C., Wilson, J. R., Holstein, J. H., Kurd, M. F., Firoozabadi, R., Vialle, L. R., Oner, F. C., Kandziora, F., Chapman, J. R., Schnake, K. J., Benneker, L. M., Dvorak, M. F., Rajasekaran, S., Vialle, E. N., Joaquim, A. F., … Bellabarba, C. (2020). Description and Reliability of the AOSpine Sacral Classification System. The Journal of bone and joint surgery. American volume, 102(16), 1454–1463. https://doi.org/10.2106/JBJS.19.01153
Disciplines
Business Administration, Management, and Operations | Health and Medical Administration | Management Sciences and Quantitative Methods
PubMedID
32816418
Department(s)
Administration and Leadership
Document Type
Article