Jason W Savage1, Timothy A Moore, Paul M Arnold, Nikhil Thakur, Wellington K Hsu, Alpesh A Patel, Kathryn McCarthy, Gregory D Schroeder, Alexander R Vaccaro, John R Dimar, Paul A Anderson. 1. *Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL †Department of Orthopaedic Surgery, Case Western Reserve, MetroHealth, Cleveland, OH ‡Department of Neurological Surgery, University of Kansas City, Kansas City, KS §Department of Orthopaedic Surgery, SUNY Upstate University Hospital, Syracuse, NY ¶Department of Orthopaedic Surgery, Arkansas Specialty Orthopaedics, Little Rock ∥Department of Orthopaedic Surgery, Thomas Jefferson University, Rothman Institute, Philadelphia, PA **Department of Orthopaedic Surgery, University of Louisville, Norton Leatherman Spine Center, Louisville, KY; and ††Department of Orthopaedic Surgery, University of Wisconsin-Madison, Madison.
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.
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.
Authors: José H Jiménez-Almonte; John D King; T David Luo; R Carter Cassidy; Arun Aneja Journal: Clin Orthop Relat Res Date: 2018-06 Impact factor: 4.176
Authors: Andrew Z Mo; Patricia E Miller; Javier Pizones; Ilkka Helenius; Michael Ruf; Ron El-Hawary; Rafael Garcia de Oliveira; Dror Ovadia; Noriaki Kawakami; Haemish Crawford; Thierry Odent; Muharrem Yazici; Michael B Johnson; Firoz Miyanji; Daniel J Hedequist Journal: J Child Orthop Date: 2021-10-01 Impact factor: 1.548
Authors: David Morgonsköld; Victoria Warkander; Panayiotis Savvides; Axel Wihlborg; Mathilde Bouzereau; Hans Möller; Paul Gerdhem Journal: World J Orthop Date: 2019-01-18