Dandurand, Charlotte; Dvorak, Marcel F; Hazenbiller, Olesja; Bransford, Richard J; Schnake, Klaus J; Vaccaro, Alexander R; Benneker, Lorin M; Vialle, Emiliano; Schroeder, Gregory D; Rajasekaran, Shanmuganathan; El-Skarkawi, Mohammad; Kanna, Rishi M; Aly, Mohamed M; Holas, Martin; Canseco, Jose A; Muijs, Sander; Popescu, Eugen C; Tee, Jin Wee; Camino-Willhuber, Gaston; Joaquim, Andrei Fernandes; ... (2024). Using Equipoise to Determine the Radiographic Characteristics Leading to Agreement on Best Treatment for Thoracolumbar Burst Fractures Without Neurologic Deficits. Global spine journal, 14(1_suppl), 25S-31S. Sage 10.1177/21925682231215770
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STUDY DESIGN
Retrospective analysis of prospectively collected data.
OBJECTIVES
Our goal was to assess radiographic characteristics associated with agreement and disagreement in treatment recommendation in thoracolumbar (TL) burst fractures.
METHODS
A panel of 22 AO Spine Knowledge Forum Trauma experts reviewed 183 cases and were asked to: (1) classify the fracture; (2) assess degree of certainty of PLC disruption; (3) assess degree of comminution; and (4) make a treatment recommendation. Equipoise threshold used was 77% (77:23 distribution of uncertainty or 17 vs 5 experts). Two groups were created: consensus vs equipoise.
RESULTS
Of the 183 cases reviewed, the experts reached full consensus in only 8 cases (4.4%). Eighty-one cases (44.3%) were included in the agreement group and 102 cases (55.7%) in the equipoise group. A3/A4 fractures were more common in the equipoise group (92.0% vs 83.7%, P < .001). The agreement group had higher degree of certainty of PLC disruption [35.8% (SD 34.2) vs 27.6 (SD 27.3), P < .001] and more common use of the M1 modifier (44.3% vs 38.3%, P < .001). Overall, the degree of comminution was slightly higher in the equipoise group [47.8 (SD 20.5) vs 45.7 (SD 23.4), P < .001].
CONCLUSIONS
The agreement group had a higher degree of certainty of PLC injury and more common use of M1 modifier (more type B fractures). The equipoise group had more A3/A4 type fractures. Future studies are required to identify the role of comminution in decision making as degree of comminution was slightly higher in the equipoise group.
Item Type: |
Journal Article (Original Article) |
|---|---|
Division/Institute: |
04 Faculty of Medicine > Department of Orthopaedic, Plastic and Hand Surgery (DOPH) > Clinic of Orthopaedic Surgery |
UniBE Contributor: |
Bigdon, Sebastian |
Subjects: |
600 Technology > 610 Medicine & health |
ISSN: |
2192-5682 |
Publisher: |
Sage |
Language: |
English |
Submitter: |
Pubmed Import |
Date Deposited: |
12 Feb 2024 16:19 |
Last Modified: |
13 Feb 2024 13:13 |
Publisher DOI: |
10.1177/21925682231215770 |
PubMed ID: |
38324599 |
Uncontrolled Keywords: |
AO spine thoracolumbar injury classification system equipoise reliability thoracolumbar fractures |
BORIS DOI: |
10.48350/192668 |
URI: |
https://boris.unibe.ch/id/eprint/192668 |
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