INTRA- AND INTER-OBSERVER AGREEMENT IN THE AO AND GARNAVOS SYSTEMS FOR DIAPHYSEAL HUMERUS FRACTURE

ABSTRACT Objective: The objective of this study was to compare inter- and intra-observer agreement using the Garnavos and AO/ASIF systems for classifying humeral diaphysis fractures . Methods: Eighty X-ray images taken of humeral diaphysis fractures in adult patients (age≥18 years) between January 2013 and September 2015 in the Radiology Department of Hospital São Paulo were selected for subsequent classification by five orthopedic surgeons with differing levels of experience. The images were examined at two different times and reproducibility analysis was evaluated using Fleiss’ kappa to verify intra- and inter-observer agreement . Results: High-level agreement was observed for both classification systems, but particularly for the AO/ASIF classification. Inter-observer evaluation yielded excellent levels of agreement for both classifications, but principally for the Garnavos classification . Conclusions: Good or excellent inter- and intra-observer agreement was seen for both the AO/ASIF and Garnavos classification systems. However, intra-observer agreement was higher for the AO/ASIF system and inter-observer agreement was higher for the Garnavos classification. Level of Evidence II, Diagnostic Studies - Investigating a Diagnostic Examination.

摘要
目的：本研究旨在对比Garnavos分型（Garnavos）与AO/ASIF分型（AO/ASIF）系统在肱骨干骨折分类中的观察者间与观察者内一致性。
方法：选取2013年1月至2015年9月间，圣保罗医院放射科收治的80例成年患者（年龄≥18岁）肱骨干骨折X线影像，由5名经验水平各异的骨科医师进行后续分型评估。所有影像经两次独立阅片，采用Fleissκ系数（Fleiss’ kappa）进行可重复性分析，以验证观察者内及观察者间一致性。
结果：两种分型系统均呈现较高一致性，其中AO/ASIF分型的一致性尤为突出；观察者间一致性评估显示，两种分型均达到优秀水平，其中尤以Garnavos分型为显著。
结论：AO/ASIF与Garnavos两种分型系统均具备良好或优秀的观察者内及观察者间一致性。但AO/ASIF分型的观察者内一致性更高，而Garnavos分型的观察者间一致性更优。本研究证据等级为II级，属诊断性研究——针对诊断检查的相关研究。