title: Interobserver and intraobserver agreement of Lenke and King classifications for idiopathic scoliosis and the influence of level of professional training.
abstract: METHODS
  This is a blinded study of radiographs by observers with different levels of professional training.
  
  
  OBJECTIVE
  To determine whether the level of professional training on nonmeasured and premeasured radiographs would affect reliability of Lenke's and King's classifications for adolescent idiopathic scoliosis.
  
  
  BACKGROUND
  Both classification systems have been studied for their reliability, mainly by observers with a high level of experience in orthopedics and scoliosis surgery using premeasured radiographs.
  
  
  METHODS
  Examination of radiographs of 60 operative cases of adolescent idiopathic scoliosis was performed. On 5 occasions, 3 observers with a completely different degree of professional training measured and classified preoperative radiographs according to Lenke's or King's criteria. The results were determined by calculating the interobserver and intraobserver agreement and were quantified using two-rater and multirater kappa statistics.
  
  
  RESULTS
  The Lenke and King classifications demonstrated poor to fair interobserver and good intraobserver agreement on nonmeasured radiographs. Both classifications demonstrated good to excellent interobserver agreement on premeasured radiographs.
  
  
  CONCLUSIONS
  The results confirm that both classifications have a good reliability. On nonmeasured radiographs, the degree of professional training and the measurement process seem to influence the outcome. On premeasured radiographs, the interobserver agreement does not seem to be influenced by the level of professional training.
authors.affiliation: Spine Service, Department of Orthopaedic Surgery, University Hospital Tübingen, Tübingen, Germany. Thomas.Niemeyer@med.uni-tuebingen.de
authors.forename: Thomas
authors.initials: T
authors.lastname: Niemeyer
authors.forename: Alexandra
authors.initials: A
authors.lastname: Wolf
authors.forename: Susanne
authors.initials: S
authors.lastname: Kluba
authors.forename: Henry F
authors.initials: HF
authors.lastname: Halm
authors.forename: Klaus
authors.initials: K
authors.lastname: Dietz
authors.forename: Torsten
authors.initials: T
authors.lastname: Kluba
mesh_terms: D000293:Adolescent; D004517:Education, Professional; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015588:Observer Variation; D009985:Orthopedics / Q000379:methods*; D011859:Radiography; D015203:Reproducibility of Results; D012600:Scoliosis / Q000145:classification* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D016037:Single-Blind Method