Reliability of a novel classification system for thoracolumbar injuries: the Thoracolumbar Injury Severity Score.
METHODS
Prospective study of 5 spine surgeons rating 71 clinical cases of thoracolumbar spinal injuries using the Thoracolumbar Injury Severity Score (TLISS) and then re-rating the cases in a different order 1 month later.


OBJECTIVE
To determine the reliability of the TLISS system.


BACKGROUND
The TLISS is a recently introduced classification system for thoracolumbar spinal column injures designed to simplify injury classification and facilitate treatment decision making. Before being widely adopted, the reliability of the TLISS must be studied.


METHODS
A total of 71 cases of thoracolumbar spinal trauma were distributed on CD-ROM to 5 attending spine surgeons, including clinical/radiographic data, details of the TLISS, and a scoring sheet in which cases would be scored using the system. The surgeons were later assigned the task with the cases reordered. Intraobserver and interobserver reliability was calculated for TLISS components, total score, and surgeon's treatment decision using the Cohen unweighted kappa coefficients and Spearman rank-order correlation.


RESULTS
Interrater reliability assessed by generalized kappa coefficients was 0.33 +/- 0.03 for injury mechanism, 0.91 +/- 0.02 for neurologic status, 0.35 +/- 0.03 for posterior ligamentous complex status, 0.29 +/- 0.02 for TLISS total, and 0.52 +/- 0.03 for treatment recommendation. Respective results using the Spearman correlation were 0.35 +/- 0.04, 0.94 +/- 0.01, 0.48 +/- 0.04, 0.65 +/- 0.03, and 0.51 +/- 0.04. Surgeons agreed with the TLISS recommendation 96.4% of the time. Intrarater kappa coefficients were 0.57 +/- 0.04 for injury mechanism, 0.93 +/- 0.02 for neurologic status, 0.48 +/- 0.04 for posterior ligamentous complex status, 0.46 +/- 0.03 for TLISS total, and 0.62 +/- 0.04 for treatment recommendation. Respective results using the Spearman correlation were 0.70 +/- 0.04, 0.95 +/- 0.02, 0.59 +/- 0.05, 0.77 +/- 0.04, and 0.59 +/- 0.05.


CONCLUSIONS
The TLISS has good reliability and compares favorably to other contemporary thoracolumbar fracture classification systems.
Vaccaro
Alexander R
AR
Thomas Jefferson University Hospital, Philadelphia, PA, USA. alexvaccaro3@aol.com
Baron
Eli M
EM
Sanfilippo
James
J
Jacoby
Sidney
S
Steuve
Jacob
J
Grossman
Eric
E
DiPaola
Matthew
M
Ranier
Paul
P
Austin
Luke
L
Ropiak
Ray
R
Ciminello
Michael
M
Okafor
Chuka
C
Eichenbaum
Matthew
M
Rapuri
Venkat
V
Smith
Eric
E
Orozco
Fabio
F
Ugolini
Peter
P
Fletcher
Mark
M
Minnich
Jonathan
J
Goldberg
Gregory
G
Wilsey
Jared
J
Lee
Joon Y
JY
Lim
Moe R
MR
Burns
Anthony
A
Marino
Ralph
R
DiPaola
Christian
C
Zeiller
Laura
L
Zeiler
Steven C
SC
Harrop
James
J
Anderson
D Greg
DG
Albert
Todd J
TJ
Hilibrand
Alan S
AS