classification of early onset scoliosis (c-eos) has almost perfect inter and intra observer...
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Classification of Early Onset Scoliosis (C-EOS) Has Almost Perfect Inter and Intra Observer Reliability
• Micaela Cyr, BA• Tricia St. Hilaire, MPH• Zhaoxing Pan, PhD• George H. Thompson, MD• Children’s Spine Study Group• Growing Spine Study Group• Sumeet Garg, MD
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Classification of Early Onset Scoliosis (C-EOS)
Williams, B.A., et al., Development and Initial Validation of the Classification of Early-Onset Scoliosis (C-EOS). The Journal of Bone & Joint Surgery, 2014. 96(16): p. 1359-1367
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Purpose
• To evaluate the inter-observer and intra-observer reliability of the Classification of Early Onset Scoliosis (C-EOS) scheme
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Methods• 50 patient cases drawn from registry
and used to create online survey
• Survey sent to faculty, research coordinators, fellows involved with CSSG and GSSG
• Surveys sent twice to test intra-observer reliability
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Methods
Kappa value
Degree of agreement
<=0 Poor
0-0.2 Slight
0.2 - 0.4 Fair
0.4 - 0.6 Moderate
0.6 - 0.8 Substantial
0.8 - 1 Almost perfect
• Fleiss Kappa and Cohen’s Kappa used to asses inter-observer and intra-observer reliability respectively
• Hypothesis: All categories would have Kappa value 0.75 or higher
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Results• 36 total participants, 29
completed twice
• Overall Fleiss Kappa for inter-observer reliability was almost perfect for etiology (0.84), Cobb angle (0.93), kyphosis angle (0.96)
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Inter-observer reliability
Etiology Cobb Angle Kyphosis Angle0
0.1
0.2
0.3
0.4
0.5
0.6
0.7
0.8
0.9
10.9 0.91
0.96
0.78
0.95 0.96
Faculty Research Coordinators
Fleis
s K
appa V
alu
e
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Intra-observer reliability
• Overall Cohen’s Kappa for intra-observer reliability was almost perfect for etiology (0.92), Cobb angle (0.96), kyphosis angle (0.98)
• Intra-observer reliability was almost perfect across all major categories for all groups
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Conclusions• Etiology most difficult to classify, still
demonstrates high reliability
• High reliability with minimal training, varying degrees of familiarity with the system
• C-EOS can be used as a reliable tool
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References• 1. Lenke, L.G., et al., Adolescent idiopathic scoliosis a new classification to
determine extent of spinal arthrodesis. The Journal of Bone & Joint Surgery, 2001. 83(8): p. 1169-1181.
• 2. Clavien, P.A., et al., The Clavien-Dindo classification of surgical complications: five-year experience. Annals of surgery, 2009. 250(2): p. 187-196.
• 3. Sink, E.L., et al., Reliability of a complication classification system for orthopaedic surgery. Clinical Orthopaedics and Related Research®, 2012. 470(8): p. 2220-2226.
• 4. Williams, B.A., et al., Development and Initial Validation of the Classification of Early-Onset Scoliosis (C-EOS). The Journal of Bone & Joint Surgery, 2014. 96(16): p. 1359-1367.
• 5. Park, H.Y. The Classification for Early Onset Scoliosis (C-EOS) Predicts Timing of VEPTR Anchor Failure. in 2013 AAP National Conference and Exhibition. 2013. American Academy of Pediatrics.
• 6. Cummings, R.J., et al., Interobserver Reliability and Intraobserver Reproducibility of the System of King et al. for the Classification of Adolescent Idiopathic Scoliosis*. The Journal of Bone & Joint Surgery, 1998. 80(8): p. 1107-11.
• 7. Fleiss, J.L., B. Levin, and M.C. Paik, Statistical methods for rates and proportions. 2013: John Wiley & Sons.
• 8. Cohen, J. A coefficient of agreement for nominal scales. Educational and Psychological Measurement, 1960. 20(1): p. 37-46.
• 9. Landis, J.R. and G.G. Koch, The measurement of observer agreement for categorical data. biometrics, 1977: p. 159-174.