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Radiographic diagnosis of scapholunate dissociation among intra-articular fractures of the distal radius: interobserver reliability


Gradl, Gertraud; Neuhaus, Valentin; Fuchsberger, Thomas; Guitton, Thierry G; Prommersberger, Karl-Josef; Ring, David (2013). Radiographic diagnosis of scapholunate dissociation among intra-articular fractures of the distal radius: interobserver reliability. Journal of Hand Surgery, 38(9):1685-1690.

Abstract

PURPOSE: To evaluate the reliability and accuracy of diagnosis of scapholunate dissociation (SLD) among AO type C (compression articular) fractures of the distal radius.
METHODS: A total of 217 surgeons evaluated 21 sets of radiographs with type C fractures of the distal radius for which the status of the scapholunate interosseous ligament was established by preoperative 3-compartment computed tomographic arthrography with direct operative visualization of diagnosed SLD (reference standard). Observers were asked whether SLD was present, and if yes, whether they would recommend operative treatment. Diagnostic performance characteristics were calculated with respect to the reference standard. We assessed interobserver reliability using the Fleiss generalized kappa.
RESULTS: The interobserver agreement for radiographic diagnosis of SLD was moderate (κ = 0.44). Correct diagnosis for a given set of radiographs ranged from 8% to 98% (average, 79%) of observers. Diagnostic performance characteristics were: 69% sensitivity, 84% specificity, 84% accuracy, 68% positive predictive value, and 84% negative predictive value. Based on a prevalence of 5%, Bayes adjusted positive and negative predictive values were 18% and 98%, respectively. Raters recommended operative treatment in 74% to 100% of patients diagnosed with SLD.
CONCLUSIONS: Radiographs are moderately reliable and are better at ruling out than ruling in SLD associated with type C fracture of the distal radius.

Abstract

PURPOSE: To evaluate the reliability and accuracy of diagnosis of scapholunate dissociation (SLD) among AO type C (compression articular) fractures of the distal radius.
METHODS: A total of 217 surgeons evaluated 21 sets of radiographs with type C fractures of the distal radius for which the status of the scapholunate interosseous ligament was established by preoperative 3-compartment computed tomographic arthrography with direct operative visualization of diagnosed SLD (reference standard). Observers were asked whether SLD was present, and if yes, whether they would recommend operative treatment. Diagnostic performance characteristics were calculated with respect to the reference standard. We assessed interobserver reliability using the Fleiss generalized kappa.
RESULTS: The interobserver agreement for radiographic diagnosis of SLD was moderate (κ = 0.44). Correct diagnosis for a given set of radiographs ranged from 8% to 98% (average, 79%) of observers. Diagnostic performance characteristics were: 69% sensitivity, 84% specificity, 84% accuracy, 68% positive predictive value, and 84% negative predictive value. Based on a prevalence of 5%, Bayes adjusted positive and negative predictive values were 18% and 98%, respectively. Raters recommended operative treatment in 74% to 100% of patients diagnosed with SLD.
CONCLUSIONS: Radiographs are moderately reliable and are better at ruling out than ruling in SLD associated with type C fracture of the distal radius.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Department of Trauma Surgery
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:September 2013
Deposited On:02 Dec 2013 08:24
Last Modified:05 Jan 2017 14:49
Publisher:Elsevier
ISSN:0363-5023
Publisher DOI:https://doi.org/10.1016/j.jhsa.2013.05.039
PubMed ID:23910379

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