title: The adoption of a new classification system: time-dependent variation in interobserver reliability of the thoracolumbar injury severity score classification system.
abstract: METHODS
  Prospective clinical assessment of the interobserver reliability of the Thoracolumbar Injury Classification and Severity Score (TLISS) in a series of consecutive patients.
  
  
  OBJECTIVE
  To evaluate the time-dependent changes in interobserver reliability of the TLISS system.
  
  
  BACKGROUND
  Reliability of an injury classification system is fundamental to its usefulness. A system that can be taught and implemented effectively will be highly reliable. Vaccaro et al recently introduced a novel thoracolumbar injury classification and treatment recommendation system called the "Thoracolumbar Injury Classification and Severity Score." An improvement over previous traumatic thoracolumbar systems, it has been designed to be both descriptive as well as prognostic. To define better the benefits of this system, the purpose of our study was to assess the time-dependent changes associated with implementation of the TLISS system at 1 institution.
  
  
  METHODS
  Seventy-one consecutive patients presenting with acute thoracolumbar injury were prospectively assessed at a single training institution. Plain radiographs, computed tomography, and magnetic resonance imaging were independently reviewed, and each case was classified according to the TLISS system. Seven months later, 25 consecutive patients presenting with acute thoracolumbar injuries were prospectively assessed at the same institution. TLISS classification criteria were again applied after reviewing plain radiographs, computed tomography, and magnetic resonance imaging. The unweighted Cohen kappa coefficient and Spearman correlation values were calculated to assess interobserver reliability at each assessment time. Interobserved reliability at the time of the first assessment was then compared with interobserver reliability from the second assessment.
  
  
  RESULTS
  Statistically significant (P < 0.05) improvements in interobserver reliability were observed. Both the unweighted Cohen kappa coefficient and Spearman correlation values increased across all comparable fields: TLISS subscores (mechanism of injury, posterior ligamentous complex), total TLISS, and TLISS management scores.
  
  
  CONCLUSIONS
  The significant improvements observed in interobserver reliability of the TLISS system suggest that the classification system can be taught effectively and be readily incorporated into daily practice. The strong correlation values obtained at the second assessment time suggest that the TLISS system may be reproducibly used to describe thoracolumbar injuries.
authors.affiliation: Department of Orthopaedic Surgery, University of Utah, Salt Lake City, UT 84108, USA. alpesh2@yahoo.com
authors.forename: Alpesh A
authors.initials: AA
authors.lastname: Patel
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Albert
authors.forename: Alan S
authors.initials: AS
authors.lastname: Hilibrand
authors.forename: James S
authors.initials: JS
authors.lastname: Harrop
authors.forename: D Greg
authors.initials: DG
authors.lastname: Anderson
authors.forename: Ashwani
authors.initials: A
authors.lastname: Sharan
authors.forename: Peter G
authors.initials: PG
authors.lastname: Whang
authors.forename: Kornelius A
authors.initials: KA
authors.lastname: Poelstra
authors.forename: Paul
authors.initials: P
authors.lastname: Arnold
authors.forename: John
authors.initials: J
authors.lastname: Dimar
authors.forename: Ignacio
authors.initials: I
authors.lastname: Madrazo
authors.forename: Sajan
authors.initials: S
authors.lastname: Hegde
mesh_terms: D006801:Humans; D015601:Injury Severity Score; D008159:Lumbar Vertebrae / Q000293:injuries; D008279:Magnetic Resonance Imaging; D015588:Observer Variation; D011446:Prospective Studies; D013119:Spinal Cord Injuries / Q000145:classification* / Q000453:epidemiology*; D013904:Thoracic Vertebrae / Q000293:injuries; D013997:Time Factors; D014057:Tomography, X-Ray Computed