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Training improves interobserver reliability for the diagnosis of scaphoid fracture displacement

Buijze, Geert A., Guitton, Thierry G., van Dijk, C. Niek, Ring, David, Science of Variation Group and Page, Richard S. 2012, Training improves interobserver reliability for the diagnosis of scaphoid fracture displacement, Clinical orthopaedics and related research, vol. 470, no. 7, pp. 2029-2034, doi: 10.1007/s11999-012-2260-4.

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Title Training improves interobserver reliability for the diagnosis of scaphoid fracture displacement
Author(s) Buijze, Geert A.
Guitton, Thierry G.
van Dijk, C. Niek
Ring, David
Science of Variation Group
Page, Richard S.ORCID iD for Page, Richard S. orcid.org/0000-0002-2225-7144
Contributor(s) Page, Richard S.ORCID iD for Page, Richard S. orcid.org/0000-0002-2225-7144
Journal name Clinical orthopaedics and related research
Volume number 470
Issue number 7
Start page 2029
End page 2034
Total pages 6
Publisher Springer New York LLC
Place of publication New York, N. Y.
Publication date 2012-07
ISSN 0009-921X
1528-1132
Keyword(s) clinical competence
computer-assisted instruction
diagnostic errors
continuing medical education
bone fractures
observer variation
predictive value of tests
questionnaires
reproducibility of results
scaphoid bone
x-ray computed tomography
Summary Background The diagnosis of displacement in scaphoid fractures is notorious for poor interobserver reliability.

Questions/purposes We tested whether training can improve interobserver reliability and sensitivity, specificity, and accuracy for the diagnosis of scaphoid fracture displacement on radiographs and CT scans.

Methods Sixty-four orthopaedic surgeons rated a set of radiographs and CT scans of 10 displaced and 10 nondisplaced scaphoid fractures for the presence of displacement, using a web-based rating application. Before rating, observers were randomized to a training group (34 observers) and a nontraining group (30 observers). The training group received an online training module before the rating session, and the nontraining group did not. Interobserver reliability for training and nontraining was assessed by Siegel’s multirater kappa and the Z-test was used to test for significance.

Results There was a small, but significant difference in the interobserver reliability for displacement ratings in favor of the training group compared with the nontraining group. Ratings of radiographs and CT scans combined resulted in moderate agreement for both groups. The average sensitivity, specificity, and accuracy of diagnosing displacement of scaphoid fractures were, respectively, 83%, 85%, and 84% for the nontraining group and 87%, 86%, and 87% for the training group. Assuming a 5% prevalence of fracture displacement, the positive predictive value was 0.23 in the nontraining group and 0.25 in the training group. The negative predictive value was 0.99 in both groups.

Conclusions Our results suggest training can improve interobserver reliability and sensitivity, specificity and accuracy for the diagnosis of scaphoid fracture displacement, but the improvements are slight. These findings are encouraging for future research regarding interobserver variation and how to reduce it further.
Language eng
DOI 10.1007/s11999-012-2260-4
Field of Research 119999 Medical and Health Sciences not elsewhere classified
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2012, Springer
Persistent URL http://hdl.handle.net/10536/DRO/DU:30047473

Document type: Journal Article
Collection: School of Medicine
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Created: Thu, 30 Aug 2012, 09:33:20 EST

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