ASSESSING COBB ANGLE AGREEMENT IN COMMUNITY SPINE RADIOGRAPHS: CLINICAL SIGNIFICANCE IN ADOLESCENT IDIOPATHIC SCOLIOSIS PATIENTS
Notice bibliographique
Résumé
Primary care physicians rely on community radiology reports to confirm an Adolescent Idiopathic Scoliosis (AIS) diagnosis prior to spine specialist referral. Accurate reporting of spine x-rays is essential as results guide management. While Cobb angle is known to have excellent reliability, this may be over-reported, specific to orthopaedic specialists and with some studies pre-determining end-vertebrae. The study objectives were 1) to determine the agreement of Cobb angle readings between index evaluation of community spine x-ray and re-evaluation of the same image by tertiary-care clinicians (spine specialist and pediatric radiologist) and 2) to determine if inaccurate measurements were associated with late AIS referrals, defined as those who present as likely surgical candidates on initial presentation. A review of AIS patients (n=170) seen for an initial visit at a tertiary-care pediatric hospital between January-September 2021 was conducted, excluding those seen for second opinion, missing index Cobb angle or with index imaging from the same institution. Community index spine x-rays available on the institution's PACS (n=119) were independently measured by two blinded raters (spine specialist and pediatric radiologist). The agreement in Cobb angle readings between community radiology and tertiary-care clinicians was measured using intraclass correlation coefficient (ICC) and the agreement in the corresponding Scoliosis Research Society management categories was measured using Fleiss’ Kappa statistic (κ). Agreement statistics were calculated for evaluation of the reference standard 3-foot standing spine x-ray in the same cohort. Bland-Altman plots were constructed to compare raters on index image and reference standard. Logistic regression was used to estimate the odds of late referrals from the discrepancy in Cobb angle measurements between community radiology and reference standard when images were within 90 days (n=111). Discrepancies were defined as differences in Cobb angle measurements >5°. An adjusted model included age, imaging location, image quality and referring specialty. Most index x-rays (72.6%) were obtained at a private community clinic. The agreement in Cobb angle on the index x-ray between community radiologist and spine specialist was fair (ICC=0.78 95% CI 0.66-0.86, SEM=6.14°) with moderate agreement in corresponding management (κ=0.58). On the same image, the agreement between community radiologist and pediatric radiologist remains fair (ICC=0.74 95% CI 0.65-0.81, SEM=6.73°) though improved agreement in corresponding management (κ=0.65). Comparatively, the agreement between spine specialist and pediatric radiologist on both index and reference standard was excellent (ICC=0.96, 95% CI 0.89-0.98, SEM=2.57°; ICC=0.97, 95% CI 0.95-0.98, SEM=2.86°) with substantial agreement in corresponding management (κ=0.73; κ=0.71). The proportion of patients with discrepancies in Cobb angle measurements was 45.0% when comparing those with index images within 90 days of the reference standard. The proportion of patients who present late was 34.2%. The odds of late referral increased when there were inaccuracies in community measurements (OR = 3.55 95% CI 1.91-6.59). There are clinically important differences between community radiology and tertiary-care evaluation of spine x-rays. Inaccurate interpretation impacts timely referrals, contributing to missed opportunities for conservative treatment and increased surgical burden.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,001 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,001 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».