Interobserver reliability of the Tile classification system for pelvic fractures among radiologists and surgeons
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EMERGENCY RADIOLOGY
Interobserver reliability of the Tile classification system for pelvic fractures among radiologists and surgeons Tobias Zingg 1 & Emilie Uldry 1 & Patrick Omoumi 2 & Daniel Clerc 1 & Arnaud Monier 2 & Basile Pache 1 & Mohammed Moshebah 2 & Fabio Butti 1 & Fabio Becce 2 Received: 28 April 2020 / Revised: 24 July 2020 / Accepted: 31 August 2020 # The Author(s) 2020
Abstract Objectives To assess the interobserver reliability (IOR) of the Tile classification system, and its potential influence on outcomes, for the interpretation of CT images of pelvic fractures by radiologists and surgeons. Methods Retrospective data (1/2008–12/2016) from 238 patients with pelvic fractures were analyzed. Mean patient age was 44 years (SD 20); 66% were male. There were 54 Tile A, 82 Tile B, and 102 Tile C type injuries. The 30-day mortality rate was 15% (36/238). Six observers, three radiologists, and three surgeons with different levels of experience (attending/resident/intern) classified each fracture into one of the 26 second-order subcategories of the Tile classification. Weighted kappa coefficients were used to assess the IORs for the three main categories and nine first-order subcategories. Results The overall IORs of the Tile system for the main categories and first-order subcategories were moderate (kappa = 0.44) and fair (kappa = 0.31), respectively. IOR was fair to moderate among radiologists, but only fair among surgeons. By level of training, IOR was moderate between attendings and between residents, whereas it was only fair between interns. IOR was moderate to substantial (kappa = 0.56–0.70) between the radiology attending and resident. Association of the Tile fracture type with 30-day mortality was present based on two out of six observer ratings. Conclusions The overall IOR of the Tile classification system is only fair to moderate, increases with the level of rater experience and is better among radiologists than surgeons. In the light of these findings, results from studies using this classification system must be interpreted cautiously. Key Points • The overall interobserver reliability of the Tile pelvic fracture classification is only fair to moderate. • Interobserver reliability increases with observer experience and radiologists have higher kappa coefficients than surgeons. • Interobserver reliability has an impact on the association of the Tile classification system with mortality in two out of six cases. Keywords Reproducibility of results . Pelvic fractures . Multidetector computed tomography . Radiologists . Surgeons
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00330-020-07247-0) contains supplementary material, which is available to authorized users. * Tobias Zingg [email protected] 1
Department of Visceral Surgery, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
2
Department of Diagnostic and Interventional Radiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
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