title: Intrarater and interrater reliability and validity in the assessment of the mechanism of injury and integrity of the posterior ligamentous complex: a novel injury severity scoring system for thoracolumbar injuries. Invited submission from the Joint Section Meeting On Disorders of the Spine and Peripheral Nerves, March 2005.
abstract: OBJECTIVE
  A new classification and treatment algorithm for thoracolumbar injuries was recently introduced by Vaccaro and colleagues in 2005. A thoracolumbar injury severity scale (TLISS) was proposed for grading and guiding treatment for these injuries. The scale is based on the following: 1) the mechanism of injury; 2) the integrity of the posterior ligamentous complex (PLC); and 3) the patient's neurological status. The reliability and validity of assessing injury mechanism and the integrity of the PLC was assessed.
  
  
  METHODS
  Forty-eight spine surgeons, consisting of neurosurgeons and orthopedic surgeons, reviewed 56 clinical thoracolumbar injury case histories. Each was classified and scored to determine treatment recommendations according to a novel classification system. After 3 months the case histories were reordered and the physicians repeated the exercise. Validity of this classification was good among reviewers; the vast majority (> 90%) agreed with the system's treatment recommendations. Surgeons were unclear as to a cogent description of PLC disruption and fracture mechanism.
  
  
  CONCLUSIONS
  The TLISS demonstrated acceptable reliability in terms of intra- and interobserver agreement on the algorithm's treatment recommendations. Replacing injury mechanism with a description of injury morphology and better definition of PLC injury will improve inter- and intraobserver reliability of this injury classification system.
authors.affiliation: Department of Neurosurgery, Thomas Jefferson University and The Rothman Institute, Philadelphia, Pennsylvania, USA. james.harrop@jefferson.edu
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: R John
authors.initials: RJ
authors.lastname: Hurlbert
authors.forename: Jared T
authors.initials: JT
authors.lastname: Wilsey
authors.forename: Eli M
authors.initials: EM
authors.lastname: Baron
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.forename: Charles G
authors.initials: CG
authors.lastname: Fisher
authors.forename: Marcel F
authors.initials: MF
authors.lastname: Dvorak
authors.forename: F C
authors.initials: FC
authors.lastname: Oner
authors.forename: Kirkham B
authors.initials: KB
authors.lastname: Wood
authors.forename: Neel
authors.initials: N
authors.lastname: Anand
authors.forename: D Greg
authors.initials: DG
authors.lastname: Anderson
authors.forename: Moe R
authors.initials: MR
authors.lastname: Lim
authors.forename: Joon Y
authors.initials: JY
authors.lastname: Lee
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Bono
authors.forename: Paul M
authors.initials: PM
authors.lastname: Arnold
authors.forename: Y Raja
authors.initials: YR
authors.lastname: Rampersaud
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
mesh_terms: D000465:Algorithms; D006801:Humans; D008022:Ligaments; D009460:Neurologic Examination; D015588:Observer Variation; D010347:Patient Care Planning; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013124:Spinal Injuries / Q000145:classification* / Q000209:etiology / Q000473:pathology / Q000628:therapy*