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dc.contributor.authorJohn Ratliffen_US
dc.contributor.authorNeel Ananden_US
dc.contributor.authorAlexander Vaccaroen_US
dc.contributor.authorMoe Limen_US
dc.contributor.authorJoon Leeen_US
dc.contributor.authorPaul Arnolden_US
dc.contributor.authorJames Harropen_US
dc.contributor.authorRaja Rampersauden_US
dc.contributor.authorChristopher Bonoen_US
dc.contributor.authorRalf Gahren_US
dc.contributor.authorTrauma Study Group Spineen_US
dc.date.accessioned2009-05-05T16:16:28Z
dc.date.available2009-05-05T16:16:28Z
dc.date.issued2007-07-09en_US
dc.identifier.citationJohn Ratliff;Neel Anand;Alexander Vaccaro;Moe Lim;Joon Lee;Paul Arnold;James Harrop;Raja Rampersaud;Christopher Bono;Ralf Gahr;Trauma Study Group Spine: Regional variability in use of a novel assessment of thoracolumbar spine fractures: United States versus international surgeons. World Journal of Emergency Surgery 2007, 2(1):24.en_US
dc.identifier.urihttp://hdl.handle.net/2271/622en_US
dc.description.abstractBACKGROUND:Considerable variability exists in clinical approaches to thoracolumbar fractures. Controversy in evaluation and nomenclature contribute to this confusion, with significant differences found between physicians, between different specialties, and in different geographic regions. A new classification system for thoracolumbar injuries, the Thoracolumbar Injury Severity Score (TLISS), was recently described by Vaccaro. No assessment of regional differences has been described. We report regional variability in use of the TLISS system between United States and non-US surgeons.METHODS:Twenty-eight spine surgeons (8 neurosurgeons and 20 orthopedic surgeons) reviewed 56 clinical thoracolumbar injury case histories, which included pertinent imaging studies. Cases were classified and scored using the TLISS system. After a three month period, the case histories were re-ordered and the physicians repeated the exercise; 22 physicians completed both surveys and were used to assess intra-rater reliability. The reliability and treatment validity of the TLISS was assessed. Surgeons were grouped into US (n = 15) and non-US (n = 13) cohorts. Inter-rater (both within and between different geographic groups) and intra-rater reliability was assessed by percent agreement, Cohen's kappa, kappa with linear weighting, and Spearman's rank-order correlation.CONCLUSION:Non-US surgeons were found to have greater inter-rater reliability in injury mechanism, while agreement on neurological status and posterior ligamentous complex integrity tended to be higher among US surgeons. Inter-rater agreement on management was moderate, although it tended to be higher in US-surgeons. Inter-rater agreement between US and non-US surgeons was similar to within group inter-rater agreement for all categories. While intra-rater agreement for mechanism tended to be higher among US surgeons, intra-rater reliability for neurological status and PLC was slightly higher among non-US surgeons. Intra-rater reliability for management was substantial in both US and non-US surgeons. The TLISS incorporates generally accepted features of spinal injury assessment into a simple patient evaluation tool. The management recommendation of the treatment algorithm component of the TLISS shows good inter-rater and substantial intra-rater reliability in both non-US and US based spine surgeons. The TLISS may improve communication between health providers and may contribute to more efficient management of thoracolumbar injuries.en_US
dc.languageenen_US
dc.language.isoen_USen_US
dc.publisherBioMedCentralen_US
dc.relation.isversionofhttp://www.wjes.org/content/2/1/24en_US
dc.relation.hasversionhttp://www.biomedcentral.com/content/pdf/1749-7922-2-24.pdfen_US
dc.rightsThis is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.en_US
dc.rights.urihttp://creativecommons.org/licenses/by/2.0en_US
dc.titleRegional variability in use of a novel assessment of thoracolumbar spine fractures: United States versus international surgeonsen_US
dc.typeArticleen_US
dc.identifier.doi10.1186/1749-7922-2-24en_US
dc.identifier.pmid17620141en_US
dc.rights.accessrightsopenAccessen_US
dc.date.captured2009-04-27en_US


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This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Except where otherwise noted, this item's license is described as: This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.