Intra- and interdisciplinary agreement in the rating of acromioclavicular joint dislocations.
BACKGROUND
Acromioclavicular (AC) joint dislocation is a common injury observed and treated by physicians from several disciplines; proper classification and communication of the diagnosis between physicians is essential to manage injuries properly. This study assessed inter- and intradepartmental agreement in the rating of AC joint dislocations and compared departments of orthopedic surgery, musculoskeletal (MSK) radiology, and emergency medicine (EM).


METHODS
Fifty radiographs indicating a random distribution of AC dislocations (Rockwood types I, II, III, and V) were sent to 25 resident, fellow, and attending physicians; the study group consisted of orthopedic surgeons (n = 9), MSK radiologists (n = 7), and EM physicians (n = 9). Dislocations were rated by physicians using the Rockwood classification (excluding type IV) and rating agreement was derived using the multirater κ statistic.


RESULTS
Moderate rating agreement was found among orthopedic surgeons (κ = 0.5147), which was higher than among radiologists (κ = 0.3628) or EM physicians (κ = 0.1894). Interdisciplinary rating agreement was highest between orthopedic surgeons and MSK radiologists and lowest between MSK radiologists and EM physicians. Attending orthopedic surgeons showed the highest rating agreement (κ = 0.5167) compared with attending MSK radiologists (κ = 0.3585) and attending EM physicians (κ = 0.2612). In-training orthopedic surgeons had higher rating agreement (κ = 0.4918) than in-training MSK radiologists (κ = 0.4218) and in-training EM physicians (κ = 0.1410).


CONCLUSIONS
Orthopedic surgeons exhibited the highest intradepartmental rating agreement in assessing AC joint injuries, but interdepartmental rating agreement was low. It is unclear if low interdepartmental rating agreement reflects classification or training weaknesses; recognition of these differences may help develop a more standardized education for physicians to improve the management of AC joint injuries.


CONCLUSIONS
Interdisciplinary rating agreement of AC joint injuries is low. Further study may help improve education and communication about AC joint injuries among physicians.
Department of Orthopedic Surgery, Beaumont Health System, Royal Oak, MI.
Matthew
M
Pifer
Kashif
K
Ashfaq
Tristan
T
Maerz
Atiba
A
Jackson
Kevin
K
Baker
Kyle
K
Anderson
D000173:Acromioclavicular Joint / Q000000981:diagnostic imaging* / Q000293:injuries*; D004635:Emergency Medicine; D005257:Fellowships and Scholarships; D006801:Humans; D007396:Internship and Residency; D004204:Joint Dislocations / Q000145:classification* / Q000000981:diagnostic imaging*; D015588:Observer Variation; D009985:Orthopedics; D011859:Radiography; D011871:Radiology