title: Interobserver and Intraobserver Reliability of Sub-Axial Injury Classification and Severity Scale between Radiologist, Resident and Spine Surgeon.
abstract: OBJECTIVE
  The sub-axial injury classification (SLIC) and severity scale was developed to decide whether to operate the cervical injured patient or not, but the reliability of SLIC and severity scale among the different physicians was not well known. Therefore, we evaluated the reliability of SLIC among a spine surgeon, a resident of neurosurgery and a neuro-radiologist.
  
  
  METHODS
  In retrograde review in single hospital from 2002 to 2009 years, 75 cases of sub-axial spine injured patients underwent operation. Each case was blindly reviewed for the SLIC and severity scale by 3 different observers by two times with 4 weeks interval with randomly allocated. The compared axis was the injury morphology score, the disco-ligamentous complex score, the neurological status score and total SLIC score; the neurological status score was derived from the review of medical record. The kappa value was used for the statistical analysis.
  
  
  RESULTS
  Interobserver agreement of SLIC and severity scale was substantial agreement in the score of injury morphology [intraclass correlation (ICC)=0.603] and total SLIC and severity sacle (ICC value=0.775), but was fair agreement in the disco-ligamentous complex score (ICC value=0.304). Intraobserver agreements were almost perfect agreement in whole scales with ICC of 0.974 in a spine surgeon, 0.948 in a resident of neurosurgery, and 0.963 in a neuro-radiologist.
  
  
  CONCLUSIONS
  The SLIC and severity scale is comprehensive and easily applicable tool in spine injured patient. Moreover, it is very useful tool to communicate among spine surgeons, residents of neurosurgery and neuro-radiologists with sufficient reproducibility.
authors.affiliation: Department of Neurosurgery, Inha University College of Medicine, Incheon, Korea.
authors.forename: Woo Jin
authors.initials: WJ
authors.lastname: Lee
authors.forename: Seung Hwan
authors.initials: SH
authors.lastname: Yoon
authors.forename: Yeo Ju
authors.initials: YJ
authors.lastname: Kim
authors.forename: Ji Yong
authors.initials: JY
authors.lastname: Kim
authors.forename: Hyung Chun
authors.initials: HC
authors.lastname: Park
authors.forename: Chon Oon
authors.initials: CO
authors.lastname: Park
keywords: Cervical spine injury; Cervical trauma; Interobserver agreement; Intraobserver reliability; Sub-axial injury classification scale