Documentation of fracture severity with the AO classification of pediatric long-bone fractures.
BACKGROUND
The AO comprehensive pediatric longbone fracture classification system describes the localization and morphology of fractures, and considers severity in 3 categories: (1) simple, (2) wedge, and (3) complex. We evaluated the reliability and accuracy of surgeons in using this rating system.


METHODS
In a first validation phase, 5 experienced pediatric (orthopedic) surgeons reviewed radiographs of 267 prospectively collected pediatric fractures (agreement study A). In a second study (B), 70 surgeons of various levels of experience in 15 clinics classified 275 fractures via internet. Simple fractures comprised about 90%, 99% and 100% of diaphyseal (D), metaphyseal (M), and epiphyseal (E) fractures, respectively.


RESULTS
Kappa coefficients for severity coding in D fractures were 0.82 and 0.51 in studies A and B, respectively. The median accuracy of surgeons in classifying simple fractures was above 97% in both studies but was lower, 85% (46-100), for wedge or complex D fractures.


CONCLUSIONS
While reliability and accuracy estimates were satisfactory as a whole, the ratings of some individual surgeons were inadequate. Our findings suggest that the classification of fracture severity in children should be done in only two categories that distinguish between simple and wedge/complex fractures.
Slongo
Theddy
T
Deptartment of Pediatric Surgery, University Children's Hospital, Bern, CH-3010.
Audigé
Laurent
L
Lutz
Nicolas
N
Frick
Steve
S
Schmittenbecher
Peter
P
Hunter
James
J
Clavert
Jean-Michel
JM
D002648:Child; D004282:Documentation; D050723:Fractures, Bone / Q000145:classification* / Q000000981:diagnostic imaging / Q000601:surgery; D006801:Humans; D006810:Humeral Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery; D015601:Injury Severity Score; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D012680:Sensitivity and Specificity; D013978:Tibial Fractures / Q000145:classification / Q000000981:diagnostic imaging / Q000601:surgery