title: Agreement in the assessment of metastatic spine disease using scoring systems.
abstract: OBJECTIVE
  To assess variability in the use of Tomita and modified Bauer scores in spine metastases.
  
  
  METHODS
  Clinical data and imaging from 90 patients with biopsy-proven spinal metastases, were provided to 83 specialists from 44 hospitals. Spinal levels involved and the Tomita and modified Bauer scores for each case were determined twice by each clinician, with a minimum of 6-week interval. Clinicians were blinded to every evaluation. Kappa statistic was used to assess intra and inter-observer agreement. Subgroup analyses were performed according to clinicians' specialty (medical oncology, neurosurgery, radiology, orthopedic surgery and radiation oncology), years of experience (⩽7, 8-13, ⩾14), and type of hospital (four levels).
  
  
  RESULTS
  For metastases identification, intra-observer agreement was "substantial" (0.60<k<0.80) at sacrum, and "almost perfect" (k>0.80) at the other levels. Inter-observer agreement was "almost perfect" at lumbar spine, and "substantial" at the other levels. Intra-observer agreement for the Tomita and Bauer scores was almost perfect. Inter-observer agreement was almost perfect for the Tomita score and substantial for the Bauer one. Results were similar across specialties, years of experience and type of hospital.
  
  
  CONCLUSIONS
  Agreement in the assessment of metastatic spine disease is high. These scoring systems can improve communication among clinicians involved in oncology care.
authors: Department of Radiology, Valencian Oncology Institute Foundation, Valencia, Spain; Research Institute in Health Services Foundation, Valencia, Spain; Spanish Back Pain Research Network, Kovacs Foundation, Palma de Mallorca, Spain. Electronic address: aranae@uv.es.
authors: Estanislao
authors: E
authors: Arana
authors: Spanish Back Pain Research Network, Kovacs Foundation, Palma de Mallorca, Spain; Scientific Department, Kovacs Foundation, Palma de Mallorca, Spain.
authors: Francisco M
authors: FM
authors: Kovacs
authors: Spanish Back Pain Research Network, Kovacs Foundation, Palma de Mallorca, Spain; CIBER Epidemiology and Public Health (CIBERESP), Spain; Clinical Biostatistics Unit, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain.
authors: Ana
authors: A
authors: Royuela
authors: Spanish Back Pain Research Network, Kovacs Foundation, Palma de Mallorca, Spain; Department of Radiology, Hospital Regional Universitario Carlos Haya, Málaga, Spain.
authors: Beatriz
authors: B
authors: Asenjo
authors: Spanish Back Pain Research Network, Kovacs Foundation, Palma de Mallorca, Spain; Center for Biomaterials and Tissue Engineering, Universitat Politècnica de València, Valencia, Spain.
authors: Ursula
authors: U
authors: Pérez-Ramírez
authors: Spanish Back Pain Research Network, Kovacs Foundation, Palma de Mallorca, Spain; CIBER Epidemiology and Public Health (CIBERESP), Spain; Clinical Biostatistics Unit, Hospital Ramón y Cajal, IRYCIS, Madrid, Spain; Barts and the London School of Medicine & Dentistry. Queen Mary University of London, London, UK.
authors: Javier
authors: J
authors: Zamora
mesh_terms: D001706:Biopsy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures; D011859:Radiography; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging* / Q000556:secondary / Q000601:surgery
keywords: Agreement; Classification; Interobserver variability; Intraobserver variability; Magnetic resonance imaging; Spine metastases