Background Context

Prior upper cervical spine injury classification systems have focused on injuries to the craniocervical junction (CCJ), atlas, and dens independently. However, no previous system has classified upper cervical spine injuries using a comprehensive system incorporating all injuries from the occiput to the C2–3 joint.

Purpose

To (1) determine the accuracy of experts at correctly classifying upper cervical spine injuries based on the recently proposed AO Spine Upper Cervical Injury Classification System (2) to determine their interobserver reliability and (3) identify the intraobserver reproducibility of the experts.

Study Design/Setting

International Multi-Center Survey.

Patient Sample

A survey of international spine surgeons on 29 unique upper cervical spine injuries.

Outcome Measures

Classification accuracy, interobserver reliability, intraobserver reproducibility.

Methods

Thirteen international AO Spine Knowledge Forum Trauma members participated in two live webinar-based classifications of 29 upper cervical spine injuries presented in random order, four weeks apart. Percent agreement with the gold-standard and kappa coefficients (ƙ) were calculated to determine the interobserver reliability and intraobserver reproducibility.

Results

Raters demonstrated 80.8% and 82.7% accuracy with identification of the injury classification (combined location and type) on the first and second assessment, respectively. Injury classification intraobserver reproducibility was excellent (mean, [range] ƙ=0.82 [0.58-1.00]). Excellent interobserver reliability was found for injury location (ƙ = 0.922 and ƙ=0.912) on both assessments, while injury type was substantial (ƙ=0.689 and 0.699) on both assessments. This correlated to a substantial overall interobserver reliability (ƙ=0.729 and 0.732).

ConclusioNS

Early phase validation demonstrated classification of upper cervical spine injuries using the AO Spine Upper Cervical Injury Classification System to be accurate, reliable, and reproducible. Greater than 80% accuracy was detected for injury classification. The intraobserver reproducibility was excellent, while the interobserver reliability was substantial.

中文翻译：

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AO 脊柱上颈椎损伤分类系统：描述和可靠性研究

背景语境

先前的上颈椎损伤分类系统分别关注颅颈交界处 (CCJ)、寰椎和牙窝的损伤。然而，以前的系统没有使用综合系统对上颈椎损伤进行分类，该系统包含从枕骨到 C2-3 关节的所有损伤。

目的

(1) 确定专家根据最近提出的 AO 脊柱上颈椎损伤分类系统正确分类上颈椎损伤的准确性，(2) 确定其观察者间的可靠性，以及 (3) 确定专家观察者内的可重复性。

研究设计/设置

国际多中心调查。

患者样本

国际脊柱外科医生对 29 例独特的上颈椎损伤的调查。

结果措施

分类准确性、观察者间可靠性、观察者内可重复性。

方法

13 名国际 AO 脊柱创伤知识论坛成员参加了两次基于网络研讨会的现场分类，对 29 种上颈椎损伤进行了随机分类，相隔四个星期。计算与黄金标准和 kappa 系数 (ƙ) 的一致性百分比以确定观察者间的可靠性和观察者内的可重复性。

结果

评估者在第一次和第二次评估中分别证明了 80.8% 和 82.7% 的伤害分类（结合位置和类型）的准确性。观察者内损伤分类的可重复性非常好（平均值，[范围]ƙ=0.82 [0.58-1.00]）。两项评估的损伤位置 (ƙ = 0.922 和 ƙ=0.912) 均具有出色的观察者间可靠性，而两项评估的损伤类型均很高 (ƙ=0.689 和 0.699)。这与显着的总体观察者间可靠性相关（ƙ=0.729 和 0.732）。

结论

早期验证表明，使用 AO 脊柱上颈椎损伤分类系统对上颈椎损伤进行分类是准确、可靠和可重复的。检测到伤害分类的准确度超过 80%。观察者内的可重复性非常好，而观察者间的可靠性很高。