title: Observer agreement in pediatric semiquantitative vertebral fracture diagnosis.
abstract: BACKGROUND
  The Genant semiquantitative (GSQ) method has been a standard procedure for diagnosis of vertebral fractures in adults but has only recently been shown to be of clinical utility in children. Observer agreement using the GSQ method in this age group has not been described.
  
  
  OBJECTIVE
  To evaluate observer agreement on vertebral readability and vertebral fracture diagnosis using the GSQ method in pediatric vertebral morphometry.
  
  
  METHODS
  Spine radiographs of 186 children with acute lymphoblastic leukemia were evaluated independently by three radiologists using the same GSQ methodology as in adults. A subset of 100 radiographs was evaluated on two occasions.
  
  
  RESULTS
  An average of 4.7% of vertebrae were unreadable for the three radiologists. Intraobserver Cohen's kappa (κ) on readability ranged from 0.434 to 0.648 at the vertebral level and from 0.416 to 0.611 at the patient level, while interobserver κ for readability had a range of 0.330 to 0.504 at the vertebral level and 0.295 to 0.467 at the patient level. Intraobserver κ for the presence of vertebral fracture had a range of 0.529 to 0.726 at the vertebral level and was 0.528 to 0.767 at the patient level. Interobserver κ for fracture at the vertebral level ranged from 0.455 to 0.548 and from 0.433 to 0.486 at the patient level.
  
  
  CONCLUSIONS
  Most κ values for both intra- and interobserver agreement in applying the GSQ method to pediatric spine radiographs were in the moderate to substantial range, comparable to the performance of the technique in adult studies. The GSQ method should be considered for use in pediatric research and clinical practice.
authors: Department of Radiology and Diagnostic Imaging and Division of Endocrinology and Metabolism, Department of Medicine, University of Alberta, 6628-123 St., Edmonton, Canada, T6H 3T6, kerrygs@telusplanet.net.
authors: Kerry
authors: K
authors: Siminoski
authors: Brian
authors: B
authors: Lentle
authors: Mary Ann
authors: MA
authors: Matzinger
authors: Nazih
authors: N
authors: Shenouda
authors: Leanne M
authors: LM
authors: Ward
mesh_terms: D002675:Child, Preschool; D003937:Diagnosis, Differential; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015588:Observer Variation; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000150:complications*; D011859:Radiography; D015203:Reproducibility of Results; D016103:Spinal Fractures / Q000000981:diagnostic imaging* / Q000209:etiology*