Difficulties in the diagnosis of vertebral fracture in men: agreement between doctors.
The agreement for vertebral fracture (VF) diagnosis in men, between doctors is poor.


OBJECTIVE
To assess the agreement for VF diagnosis, in men, on standard radiographs, between experts, before and after consensual workshop and establishing an algorithm.


METHODS
The agreement between thirteen experimented rheumatologists has been calculated in thirty osteoporotic men. Then, the group discussed in a workshop and 28 other radiograph sets of osteoporotic men with follow-up radiographs and incident confirmed VF, have been reviewed. The experts identified and hierarchised 18 pathological features of vertebral deformation and established an algorithm of VF diagnosis. Eleven experts have realized a second reading of the first set of radiographs. We compared the agreement between the 2 readings without and with the algorithm.


RESULTS
After consensus and the use of the algorithm the results are: number of fractured patients (with at least 1 VF) according to the experts varies from 13 to 26 patients out of 30 (13 to 28 during the first reading). The agreement between the experts at the patient level is 75% (70% at the first reading). Among the 390 vertebrae analyzed by the experts, the number of VF detected varies from 18 to 59 (18 to 98 at the first reading). The agreement between the experts at the vertebral level is 92% (89% at the first reading). The algorithm allows a good improvement of the agreement, especially for 8 of the 11 experts. Discrepancies for the VF diagnosis between experts exist. The algorithm improves the agreement.
Paris Descartes University, Rheumatology department, Cochin Hospital, 27, rue du Faubourg-St-Jacques, 75014 Paris, France. Electronic address: jacques.fechtenbaum@cch.aphp.fr.
Jacques
J
Fechtenbaum
Paris Descartes University, Rheumatology department, Cochin Hospital, 27, rue du Faubourg-St-Jacques, 75014 Paris, France.
Karine
K
Briot
Paris Descartes University, Rheumatology department, Cochin Hospital, 27, rue du Faubourg-St-Jacques, 75014 Paris, France.
Simon
S
Paternotte
Department of rheumatology, LUNAM, CHU d'Angers, 49933 Angers cedex 09, France.
Maurice
M
Audran
Rheumatology, Hôpital l'Archet, 06202 Nice cedex, France.
Véronique
V
Breuil
Department of rheumatology, Hôpital Roger-Salengro, CHU de Lille, 59037 Lille cedex, France.
Bernard
B
Cortet
Department of rheumatology, CHU la Milétrie, 86021 Poitiers cedex, France.
Françoise
F
Debiais
Department of rheumatology, CHU Amiens Nord, 80054 Amiens cedex 1, France.
Franck
F
Grados
Department of rheumatology, Hôpital Sud, CHU de Rennes, 35203 Rennes cedex 2, France.
Pascal
P
Guggenbuhl
Department of rheumatology, Hôpital Purpan, 31059 Toulouse cedex 09, France.
Michel
M
Laroche
Department of rheumatology, LUNAM, CHU d'Angers, 49933 Angers cedex 09, France.
Erick
E
Legrand
Department of rheumatology, CHR la Source, 45067 Orléans cedex 2, France.
Eric
E
Lespessailles
Department of rheumatology, CHU Côte de Nacre, 14033 Caen cedex, France.
Christian
C
Marcelli
Department of rheumatology, CHU Lariboisière, 75475 Paris cedex 10, France.
Philippe
P
Orcel
Inserm, Hôpital de Lyon, 69437 Lyon cedex, France.
Pawel
P
Szulc
Department of rheumatology, Hôpital Nord, CHU de Saint-Étienne, 42055 Saint-Étienne, France.
Thierry
T
Thomas
Paris Descartes University, Rheumatology department, Cochin Hospital, 27, rue du Faubourg-St-Jacques, 75014 Paris, France.
Sami
S
Kolta
Paris Descartes University, Rheumatology department, Cochin Hospital, 27, rue du Faubourg-St-Jacques, 75014 Paris, France.
Christian
C
Roux
D000465:Algorithms; D006801:Humans; D008297:Male; D015588:Observer Variation; D058866:Osteoporotic Fractures / Q000000981:diagnostic imaging*; D011859:Radiography; D012219:Rheumatology / Q000193:education; D016103:Spinal Fractures / Q000000981:diagnostic imaging*
Algorithm; Diagnosis of vertebral fractures; Male osteoporosis; Radiography; Vertebral fracture