title: Validity and reliability of a method for assessment of cervical vertebral maturation.
abstract: OBJECTIVE
  To evaluate the validity and reliability of the cervical vertebral maturation (CVM) method with a longitudinal sample.
  
  
  METHODS
  Eighty-six cephalograms from 18 subjects (5 males and 13 females) were selected from the longitudinal database. Total mandibular length was measured on each film; an increased rate served as the gold standard in examination of the validity of the CVM method. Eleven orthodontists, after receiving intensive training in the CVM method, evaluated all films twice. Kendall's W and the weighted kappa statistic were employed.
  
  
  RESULTS
  Kendall's W values were higher than 0.8 at both times, indicating strong interobserver reproducibility, but interobserver agreement was documented twice at less than 50%. A wide range of intraobserver agreement was noted (40.7%-79.1%), and substantial intraobserver reproducibility was proved by kappa values (0.53-0.86). With regard to validity, moderate agreement was reported between the gold standard and observer staging at the initial time (kappa values 0.44-0.61). However, agreement seemed to be unacceptable for clinical use, especially in cervical stage 3 (26.8%).
  
  
  CONCLUSIONS
  Even though the validity and reliability of the CVM method proved statistically acceptable, we suggest that many other growth indicators should be taken into consideration in evaluating adolescent skeletal maturation.
authors.affiliation: Department of Orthodontics, Peking University School and Hospital of Stomatology, Beijing, China.
authors.forename: Xiao-Guang
authors.initials: XG
authors.lastname: Zhao
authors.forename: Jiuxiang
authors.initials: J
authors.lastname: Lin
authors.forename: Jiu-Hui
authors.initials: JH
authors.lastname: Jiang
authors.forename: Qingzhu
authors.initials: Q
authors.lastname: Wang
authors.forename: Sut Hong
authors.initials: SH
authors.lastname: Ng
mesh_terms: D000293:Adolescent; D000365:Age Determination by Skeleton / Q000379:methods / Q000592:standards*; D002508:Cephalometry / Q000379:methods; D002574:Cervical Vertebrae / Q000033:anatomy & histology / Q000254:growth & development*; D002648:Child; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted / Q000379:methods; D008137:Longitudinal Studies; D008297:Male; D008334:Mandible / Q000033:anatomy & histology / Q000254:growth & development; D015588:Observer Variation; D011627:Puberty; D055815:Young Adult