title: Surgeon reliability in rating physical deformity in adolescent idiopathic scoliosis.
abstract: METHODS
  Cross sectional survey.
  
  
  OBJECTIVE
  To compare pediatric spine surgeons' relative rankings of the importance of surgical considerations, and their reliability of ratings of the physical deformity of patients with adolescent idiopathic scoliosis (AIS).
  
  
  BACKGROUND
  Adolescents' appearance is a factor in surgical decision-making. Although the reliability of the Cobb angle has been extensively studied, less attention has been directed toward the reliability of surgeons' assessment of physical appearance.
  
  
  METHODS
  Five surgeons ranked the relative importance of 13 surgical considerations. While viewing clinical photographs of 40 patients, surgeons rated the following: shoulder blades, shoulders, waist asymmetry, and the "overall appearance" of the back.
  
  
  RESULTS
  "Severity of deformity" was consistently ranked the most important surgical consideration. Surgeons, however, varied widely in their reliability of their ratings of physical appearance: shoulder blades (kappa = 0.34), shoulders (kappa = 0.22), waist (kappa = 0.24), and overall appearance (kappa = 0.40).
  
  
  CONCLUSIONS
  Because patients' physical appearance is an important element of surgical decision-making, differences among surgeons could be contributing to inconsistent recommendations.
authors.affiliation: Division of Orthopaedic Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
authors.forename: Sandra
authors.initials: S
authors.lastname: Donaldson
authors.forename: Douglas
authors.initials: D
authors.lastname: Hedden
authors.forename: Derek
authors.initials: D
authors.lastname: Stephens
authors.forename: Benjamin
authors.initials: B
authors.lastname: Alman
authors.forename: Andrew
authors.initials: A
authors.lastname: Howard
authors.forename: Unni
authors.initials: U
authors.lastname: Narayanan
authors.forename: James G
authors.initials: JG
authors.lastname: Wright
mesh_terms: D000293:Adolescent; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D015588:Observer Variation; D009985:Orthopedics / Q000379:methods / Q000592:standards; D010820:Physicians; D012600:Scoliosis / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D012720:Severity of Illness Index