J Korean Neurosurg Soc.  2012 Sep;52(3):200-203.

Interobserver and Intraobserver Reliability of Sub-Axial Injury Classification and Severity Scale between Radiologist, Resident and Spine Surgeon

Affiliations
  • 1Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea. nsyoon@gmail.com
  • 2Department of Radiology, Inha University College of Medicine, Incheon, Korea.
  • 3Department of Neurosurgery, Korea Armed Forces Busan Hospital, Busan, Korea.

Abstract


OBJECTIVE
The sub-axial injury classification (SLIC) and severity scale was developed to decide whether to operate the cervical injured patient or not, but the reliability of SLIC and severity scale among the different physicians was not well known. Therefore, we evaluated the reliability of SLIC among a spine surgeon, a resident of neurosurgery and a neuro-radiologist.
METHODS
In retrograde review in single hospital from 2002 to 2009 years, 75 cases of sub-axial spine injured patients underwent operation. Each case was blindly reviewed for the SLIC and severity scale by 3 different observers by two times with 4 weeks interval with randomly allocated. The compared axis was the injury morphology score, the disco-ligamentous complex score, the neurological status score and total SLIC score; the neurological status score was derived from the review of medical record. The kappa value was used for the statistical analysis.
RESULTS
Interobserver agreement of SLIC and severity scale was substantial agreement in the score of injury morphology [intraclass correlation (ICC)=0.603] and total SLIC and severity sacle (ICC value=0.775), but was fair agreement in the disco-ligamentous complex score (ICC value=0.304). Intraobserver agreements were almost perfect agreement in whole scales with ICC of 0.974 in a spine surgeon, 0.948 in a resident of neurosurgery, and 0.963 in a neuro-radiologist.
CONCLUSION
The SLIC and severity scale is comprehensive and easily applicable tool in spine injured patient. Moreover, it is very useful tool to communicate among spine surgeons, residents of neurosurgery and neuro-radiologists with sufficient reproducibility.

Keyword

Cervical trauma; Sub-axial injury classification scale; Cervical spine injury; Interobserver agreement; Intraobserver reliability

MeSH Terms

Axis, Cervical Vertebra
Humans
Medical Records
Neurosurgery
Spine
Weights and Measures

Figure

  • Fig. 1 A 33-year-old male was admitted to the hospital due to traffic accident. He complained of C6 dermatome radiculopathy. Cervical spine computed tomography reveals a fracture involving right facet joint at level of C6, 7. Cervical MRI shows the enhancing lesion suggesting disco-ligamentous injury at level of C6, 7. Spine surgeon gave 2 points, resident and radiologist gave 1 point for the patient disco-ligamentous complex injury. The patient's total score was 4 form resident and radiologist, 5 from spine surgeon. Cervical anterior fusion was performed at level of C6, 7.


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