title: Agreement between orthopedic surgeons and neurosurgeons regarding a new algorithm for the treatment of thoracolumbar injuries: a multicenter reliability study.
abstract: BACKGROUND
  Considerable variability exists in the management of thoracolumbar (TL) spine injuries. Although there are many influences, one significant factor may be the treating surgeon's specialty and training (ie, orthopedic surgery vs. neurosurgery). Our objective was to assess the agreement between spinal orthopedic and neurologic surgeons in rating the severity of TL spine injuries with a new treatment algorithm. This information could be important in establishing consensus-based protocols for managing these challenging injuries.
  
  
  METHODS
  Twenty-eight spinal surgeons (8 neurosurgeons and 20 orthopedic surgeons) reviewed 56 TL injury case histories. Each case was classified and scored according to the TL injury severity score (TLISS). The case histories were reordered and the physicians repeated the exercise 3 months later. At both intervals the surgeons were asked if they agreed with the final treatment recommendation of the TLISS algorithm. The reliability and decision validity of the TLISS was compared.
  
  
  RESULTS
  Between-group interrater reliability was similar to within group reliabilities. Intrarater reliability was also similar between groups. The between speciality interrater reliability of the TLISS management recommendation was moderate (74% agreement, kappa=0.532). Orthopedic and neurosurgeons agreed with the TLISS management recommendation 91.4% and 94.4% of the time, respectively.
  
  
  CONCLUSIONS
  The TLISS demonstrated good reliability in terms of intraobserver and interobserver agreement on the algorithmic treatment recommendations. The recommendation for operation seems to be consistent between fellowship-trained orthopedic and neurosurgical spine surgeons. This type of classification system may reduce the existing variability and initial management decision for treatment of TL injuries.
authors.affiliation: Division of Orthopaedic and Neurosurgery, University of Toronto, Toronto, Ontario, Canada. raja.rampersaud@uhn.on.ca
authors.forename: Y
authors.initials: Y
authors.lastname: Raja Rampersaud
authors.forename: Charles
authors.initials: C
authors.lastname: Fisher
authors.forename: Jared
authors.initials: J
authors.lastname: Wilsey
authors.forename: Paul
authors.initials: P
authors.lastname: Arnold
authors.forename: Neel
authors.initials: N
authors.lastname: Anand
authors.forename: Chris M
authors.initials: CM
authors.lastname: Bono
authors.forename: Andrew T
authors.initials: AT
authors.lastname: Dailey
authors.forename: Marcel
authors.initials: M
authors.lastname: Dvorak
authors.forename: Michael G
authors.initials: MG
authors.lastname: Fehlings
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
authors.forename: F C
authors.initials: FC
authors.lastname: Oner
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
mesh_terms: D000465:Algorithms; D001291:Attitude of Health Personnel; D006801:Humans; D015601:Injury Severity Score; D008159:Lumbar Vertebrae / Q000293:injuries; D009493:Neurosurgery; D009985:Orthopedics; D015203:Reproducibility of Results; D013124:Spinal Injuries / Q000628:therapy*; D013904:Thoracic Vertebrae / Q000293:injuries