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Training Improves Interobserver Reliability for the Diagnosis of Scaphoid Fracture Displacement

  • Clinical Research
  • Published:
Clinical Orthopaedics and Related Research®

Abstract

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.

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Author information

Authors and Affiliations

  1. Orthopaedic Research Center Amsterdam, Department of Orthopaedic Surgery, Academic Medical Centre, Amsterdam, The Netherlands

    Geert A. Buijze MD, Thierry G. Guitton PhD & C. Niek van Dijk MD, PhD

  2. Orthopaedic Hand and Upper Extremity Service, Massachusetts General Hospital, Harvard Medical School, Yawkey Center, Suite 2100, 55 Fruit Street, Boston, MA, 02114, USA

    David Ring MD, PhD

Authors
  1. Geert A. Buijze MD
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  2. Thierry G. Guitton PhD
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  3. C. Niek van Dijk MD, PhD
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  4. David Ring MD, PhD
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Consortia

The Science of Variation Group

Corresponding author

Correspondence to David Ring MD, PhD.

Additional information

The Science of Variation Group consists of the following members: A. Lee Osterman, Abhijeet L. Wahegaonkar, Amy Ladd, Antonio Barquet, Arie B. van Vugt, Ashok K. Shyam, Carrie Swigart, Chad P. Coles, Charalampos Zalavras, Charles A. Goldfarb, Charles Cassidy, Christopher Allan, Daphne Beingessner, David M. Kalainov, Denise Eygendaal, Parag Sancheti, Robert J. Feibel, Steve Rocha, Elena Grosso, Frede Frihagen, George S.M. Dyer, George S. Athwal, J. Carel Goslings, Gregory J. Della Rocca, Ian Harris, Jason C. Fanuele, Jeff Lawton, John Jiuliano, John McAuliffe, John T. Capo, Joseph M. Conflitti, Keith Segalman, Kenneth Egol, Kornelis J. Ponsen, Kyle Jeray, Lisa Lattanza, Louis Catalano III, Marc Swiontkowski, Martin Boyer, Martin Richardson, Maximillian Soong, Michael Baskies, Michael Prayson, Michael Mckee, Neal C. Chen, P.V. van Eerten, Peter R.G. Brink, Peter J. Evans, Peter Jebson, Peter Kloen, Philip Blazar, Steven J. Rhemrev, Richard S. Page, Rick Papandrea, Rob Nelissen, Robert D. Zura, Rodrigo Pesantez, Rudolf W. Poolman, Samir Sodha, Scott Duncan, Scott Wolfe, Taco Gosens, Thomas Wright, Tim Davis.

One of the authors (GAB) has received funding from the Netherlands Organisation for Scientific Research, The Hague, The Netherlands.

All ICMJE Conflict of Interest Forms for authors and Clinical Orthopaedics and Related Research editors and board members are on file with the publication and can be viewed on request.

Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research, and that informed consent for participation in the study was obtained.

This work was performed at the Orthopaedic Hand and Upper Extremity Service of the Massachusetts General Hospital, Boston, MA, USA.

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Buijze, G.A., Guitton, T.G., van Dijk, C.N. et al. Training Improves Interobserver Reliability for the Diagnosis of Scaphoid Fracture Displacement. Clin Orthop Relat Res 470, 2029–2034 (2012). https://doi.org/10.1007/s11999-012-2260-4

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  • DOI: https://doi.org/10.1007/s11999-012-2260-4

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