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The Reliability and Validity of the Thoracolumbar Injury Classification System in Pediatric Spine Trauma
- Source :
- Spine. 40:E1014-E1018
- Publication Year :
- 2015
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2015.
-
Abstract
- STUDY DESIGN The thoracolumbar injury classification system (TLICS) was evaluated in 20 consecutive pediatric spine trauma cases. OBJECTIVE The purpose of this study was to determine the reliability and validity of the TLICS in pediatric spine trauma. SUMMARY OF BACKGROUND DATA The TLICS was developed to improve the categorization and management of thoracolumbar trauma. TLICS has been shown to have good reliability and validity in the adult population. METHODS The clinical and radiographical findings of 20 pediatric thoracolumbar fractures were prospectively presented to 20 surgeons with disparate levels of training and experience with spinal trauma. These injuries were consecutively scored using the TLICS. Cohen unweighted κ coefficients and Spearman rank order correlation values were calculated for the key parameters (injury morphology, status of posterior ligamentous complex, neurological status, TLICS total score, and proposed management) to assess the inter-rater reliabilities. Five surgeons scored the same cases 3 months later to assess the intra-rater reliability. The actual management of each case was then compared with the treatment recommended by the TLICS algorithm to assess validity. RESULTS The inter-rater κ statistics of all subgroups (injury morphology, status of the posterior ligamentous complex, neurological status, TLICS total score, and proposed treatment) were within the range of moderate to substantial reproducibility (0.524-0.958). All subgroups had excellent intra-rater reliability (0.748-1.000). The various indices for validity were calculated (80.3% correct, 0.836 sensitivity, 0.785 specificity, 0.676 positive predictive value, 0.899 negative predictive value). Overall, TLICS demonstrated good validity. CONCLUSION The TLICS has good reliability and validity when used in the pediatric population. The inter-rater reliability of predicting management and indices for validity are lower than those in adults with thoracolumbar fractures, which is likely due to differences in the way children are treated for certain types of injuries. TLICS can be used to reliably categorize thoracolumbar injuries in the pediatric population; however, modifications may be needed to better guide treatment in this specific patient population. LEVEL OF EVIDENCE 4.
- Subjects :
- Male
medicine.medical_specialty
Adolescent
Lumbar vertebrae
Pediatric spine
Thoracic Vertebrae
Injury Severity Score
Predictive Value of Tests
Humans
Medicine
Orthopedics and Sports Medicine
Prospective Studies
Child
Prospective cohort study
Reliability (statistics)
Observer Variation
Lumbar Vertebrae
business.industry
Age Factors
Reproducibility of Results
Evidence-based medicine
United States
Radiography
medicine.anatomical_structure
Spinal Injuries
Predictive value of tests
Thoracic vertebrae
Physical therapy
Female
Neurology (clinical)
business
Algorithms
Subjects
Details
- ISSN :
- 03622436
- Volume :
- 40
- Database :
- OpenAIRE
- Journal :
- Spine
- Accession number :
- edsair.doi.dedup.....41f6ba7dbe7183f5cd324fe2f96abf59