Browsing by Author "Astur, Nelson"

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    An independent inter- and intra-observer agreement assessment of the Eno classification of sacroiliac joint degeneration
    (2022) Urrutia, Julio; Camino-Willhuber, Gaston; Astur, Nelson; Valacco, Marcelo; Borensztein, Matias; Velan, Osvaldo; Cikutovic, Pablo
    Background Recently, a scoring system to grade sacroiliac joint (SIJ) degeneration using computed tomography (CT) scans was described. No independent evaluation has determined the inter- and intra-observer agreement using this scheme. Purpose To perform an independent inter- and intra-observer agreement assessment using the Eno classification and determining gas in the SIJ. Material and Methods We studied 64 patients aged >= 60 years who were evaluated with abdominal and pelvic computed tomography scans. Six physicians (three orthopaedic spine surgeons and three musculoskeletal radiologists) assessed axial images to grade SIJ degeneration into grade 0 (normal), grade 1 (mild degeneration), grade 2 (significant degeneration), and grade 3 (ankylosis). We also evaluated the agreement assessing the presence of gas in the SIJ. After a four-week interval, all cases were presented in a random sequence for repeat assessment. We determined the agreement using the kappa (kappa) or weighted kappa coefficient (w kappa). Results The inter-observer agreement was moderate (w kappa = 0.50 [0.44-0.56]), without differences among surgeons (w kappa = 0.53 [0.45-0.61]) and radiologists (w kappa = 0.49 [0.42-0.57]). The agreement evaluating the presence of gas was also moderate (kappa = 0.45 [0.35-0.54]), but radiologists obtained better agreement (kappa = 0.61 [0.48-0.72]) than surgeons (kappa = 0.29 [0.18-0.39]). The intra-observer agreement using the classification was substantial (w kappa = 0.79 [0.76-0.82]), without differences comparing surgeons (w kappa = 0.75 [0.70-0.80]) and radiologists (w kappa = 0.83 [0.79-0.87]). The intra-rater agreement evaluating gas was substantial (kappa = 0.77 [0.72-0.82]), without differences between surgeons (kappa = 0.71 [0.63-0.78]) and radiologists (kappa = 0.84 [0.78-0.90]). Conclusion Given the only moderate agreement obtained using the Eno classification, it does not seem adequate to be used in clinical practice or in research.
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    An independent inter- and intraobserver agreement assessment of the AOSpine sacral fracture classification system
    (2021) Urrutia, Julio; Meissner-Haecker, Arturo; Astur, Nelson; Valencia, Manuel; Yurac, Ratko; Camino-Willhuber, Gaston; Valacco, Marcelo
    BACKGROUND CONTEXT: The AOSpine sacral classification scheme was recently described. It demonstrated substantial interobserver and excellent intraobserver agreement in the study describing it; however, an independent assessment has not been performed.
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    An inter- and intra-rater agreement assessment of a novel classification of pyogenic spinal infections
    (2022) Camino-Willhuber, Gaston; Delgado, Byron; Astur, Nelson; Guiroy, Alfredo; Valacco, Marcelo; Nasto, Luigi Aurelio; Piccone, Luca; Barbanti-Brodano, Giovanni; Leone, Antonio; Cipolloni, Valerio; Pola, Enrico; Urrutia, Julio
    Purpose Pola et al. described a clinical-radiological classification of pyogenic spinal infections (PSI) based on magnetic resonance imaging (MRI) features including vertebral destruction, soft tissue involvement, and epidural abscess, along with the neurological status. We performed an inter- and intra-observer agreement evaluation of this classification. Methods Complete MRI studies of 80 patients with PSI were selected and classified using the scheme described by Pola et al. by seven evaluators. After a four-week interval, all cases were presented to the same assessors in a random sequence for repeat assessment. We used the weighted kappa statistics (w kappa) to establish the inter- and intra-observer agreement. Results The inter-observer agreement was substantial considering the main categories (w kappa = 0.77; 0.71-0.82), but moderate considering the subtypes (w kappa = 0.51; 0.45-0.58). The intra-observer agreement was substantial considering the main types (w kappa = 0.65; 0.59-0.71), and moderate considering the subtypes (w kappa = 0.58; 0.54-0.63). Conclusion The agreement at the main type level indicates that this classification allows adequate communication and may be used in clinical practice; at the subtypes level, the agreement is only moderate.
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    Inter- and intra-observer agreement using the new AOSpine sacral fracture classification, with a comparison between spine and pelvic trauma surgeons
    (2022) Meissner-Haecker, Arturo; Diaz-Ledezma, Claudio; Klaber, Ianiv; Zamora, Tomas; Valencia, Manuel; Camino-Willhuber, Gaston; Astur, Nelson; Yurac, Ratko; Valacco, Marcelo; Urrutia, Julio
    Background: Sacral fractures treatment frequently involves both spine and pelvic trauma surgeons; therefore, a consistent communication among surgical specialists is required. We independently assessed the new AOSpine sacral fracture classification's agreement from the perspective of spine and pelvic trauma surgeons. Methods: Complete computerized tomography (CT) scans of 80 patients with sacral fractures were selected and classified using the new AOSpine sacral classification system by six spine surgeons and three pelvic trauma surgeons. After four weeks, the 80 cases were presented and reassessed by the same raters in a new random sequence. The Kappa coefficient ( K) was used to measure the inter-and intra-observer agreement. Results: The inter-observer agreement considering the fracture severity types (A, B, or C) was substantial for spine surgeons ( K= 0.68 [0.63 - 0.72]) and pelvic trauma surgeons ( K= 0.74 (0.64 - 0.84). Regarding the subtypes, both groups achieved moderate agreement with K= 0.52 (0.49 - 0.54) for spine surgeons and K= 0.51 (0.45 - 0.57) for pelvic trauma surgeons. The intra-observer agreement considering the fracture types was substantial for spine surgeons ( K= 0.74 [0.63 - 0.75]) and almost perfect for pelvic trauma surgeons ( K= 0.84 [0.74 - 0.93]). Concerning the subtypes, both groups achieved substantial agreement with, K= 0.61 (0.56 - 0.67) for spine surgeons and K= 0.68 (0.62 - 0.74) for pelvic trauma surgeons. Conclusion: This classification allows an adequate communication for spine surgeons and pelvic trauma surgeons at the fracture severity type, but the agreement is only moderate at the subtype level. Future prospective studies are required to evaluate whether this classification allows for treatment recommendations and establishing prognosis in patients with sacral fractures. @ 2021 Elsevier Ltd. All rights reserved.