title: The Reliability and Validity of the Thoracolumbar Injury Classification System in Pediatric Spine Trauma.
abstract: METHODS
  The thoracolumbar injury classification system (TLICS) was evaluated in 20 consecutive pediatric spine trauma cases.
  
  
  OBJECTIVE
  The purpose of this study was to determine the reliability and validity of the TLICS in pediatric spine trauma.
  
  
  BACKGROUND
  The TLICS was developed to improve the categorization and management of thoracolumbar trauma. TLICS has been shown to have good reliability and validity in the adult population.
  
  
  METHODS
  The clinical and radiographical findings of 20 pediatric thoracolumbar fractures were prospectively presented to 20 surgeons with disparate levels of training and experience with spinal trauma. These injuries were consecutively scored using the TLICS. Cohen unweighted κ coefficients and Spearman rank order correlation values were calculated for the key parameters (injury morphology, status of posterior ligamentous complex, neurological status, TLICS total score, and proposed management) to assess the inter-rater reliabilities. Five surgeons scored the same cases 3 months later to assess the intra-rater reliability. The actual management of each case was then compared with the treatment recommended by the TLICS algorithm to assess validity.
  
  
  RESULTS
  The inter-rater κ statistics of all subgroups (injury morphology, status of the posterior ligamentous complex, neurological status, TLICS total score, and proposed treatment) were within the range of moderate to substantial reproducibility (0.524-0.958). All subgroups had excellent intra-rater reliability (0.748-1.000). The various indices for validity were calculated (80.3% correct, 0.836 sensitivity, 0.785 specificity, 0.676 positive predictive value, 0.899 negative predictive value). Overall, TLICS demonstrated good validity.
  
  
  CONCLUSIONS
  The TLICS has good reliability and validity when used in the pediatric population. The inter-rater reliability of predicting management and indices for validity are lower than those in adults with thoracolumbar fractures, which is likely due to differences in the way children are treated for certain types of injuries. TLICS can be used to reliably categorize thoracolumbar injuries in the pediatric population; however, modifications may be needed to better guide treatment in this specific patient population.
  
  
  METHODS
  4.
authors.affiliation: *Department of Orthopaedic Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL †Department of Orthopaedic Surgery, Case Western Reserve, MetroHealth, Cleveland, OH ‡Department of Neurological Surgery, University of Kansas City, Kansas City, KS §Department of Orthopaedic Surgery, SUNY Upstate University Hospital, Syracuse, NY ¶Department of Orthopaedic Surgery, Arkansas Specialty Orthopaedics, Little Rock ∥Department of Orthopaedic Surgery, Thomas Jefferson University, Rothman Institute, Philadelphia, PA **Department of Orthopaedic Surgery, University of Louisville, Norton Leatherman Spine Center, Louisville, KY; and ††Department of Orthopaedic Surgery, University of Wisconsin-Madison, Madison.
authors.forename: Jason W
authors.initials: JW
authors.lastname: Savage
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Moore
authors.forename: Paul M
authors.initials: PM
authors.lastname: Arnold
authors.forename: Nikhil
authors.initials: N
authors.lastname: Thakur
authors.forename: Wellington K
authors.initials: WK
authors.lastname: Hsu
authors.forename: Alpesh A
authors.initials: AA
authors.lastname: Patel
authors.forename: Kathryn
authors.initials: K
authors.lastname: McCarthy
authors.forename: Gregory D
authors.initials: GD
authors.lastname: Schroeder
authors.forename: Alexander R
authors.initials: AR
authors.lastname: Vaccaro
authors.forename: John R
authors.initials: JR
authors.lastname: Dimar
authors.forename: Paul A
authors.initials: PA
authors.lastname: Anderson
mesh_terms: D000293:Adolescent; D000367:Age Factors; D000465:Algorithms; D002648:Child; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries / Q000503:physiopathology; D008297:Male; D015588:Observer Variation; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011859:Radiography; D015203:Reproducibility of Results; D013124:Spinal Injuries / Q000145:classification / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging* / Q000293:injuries / Q000503:physiopathology; D014481:United States