title: Diagnosis of vertebral fractures in children: is a simplified algorithm-based qualitative technique reliable?
abstract: Identification of osteoporotic vertebral fractures allows treatment opportunity reducing future risk. There is no agreed standardised method for diagnosing paediatric vertebral fractures.
  
  
  
  To evaluate the precision of a modified adult algorithm-based qualitative (ABQ) technique, applicable to children with primary or secondary osteoporosis.
  
  
  
  Three radiologists independently assessed lateral spine radiographs of 50 children with suspected reduction in bone mineral density using a modified ABQ scoring system and following simplification to include only clinically relevant parameters, a simplified ABQ score. A final consensus of all observers using simplified ABQ was performed as a reference standard for fracture characterisation. Kappa was calculated for interobserver agreement of the components of both scoring systems and intraobserver agreement of simplified ABQ based on a second read of 29 randomly selected images.
  
  
  
  Interobserver Kappa for modified ABQ scoring for fracture detection, severity and shape ranged from 0.34 to 0.49 Kappa for abnormal endplate and position assessment was 0.27 to 0.38. Inter- and intraobserver Kappa for simplified ABQ scoring for fracture detection and grade ranged from 0.37 to 0.46 and 0.45 to 0.56, respectively. Inter- and intraobserver Kappa for affected endplate ranged from 0.31 to 0.41 and 0.45 to 0.51, respectively. Subjectively, observers' felt simplified ABQ was easier and less time-consuming.
  
  
  
  Observer reliability of modified and simplified ABQ was similar, with slight to moderate agreement for fracture detection and grade/severity. Due to subjective preference for simplified ABQ, we suggest its use as a semi-objective measure of diagnosing paediatric vertebral fractures.
authors.affiliation: Radiology Department, Sheffield Teaching Hospitals NHS Foundation Trust UK, Sheffield, UK.|Radiology Department, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK.
authors.forename: E
authors.initials: E
authors.lastname: Adiotomre
authors.affiliation: Sheffield Medical School, University of Sheffield UK, Sheffield, UK.
authors.forename: L
authors.initials: L
authors.lastname: Summers
authors.affiliation: School of Health and Related Research, University of Sheffield UK, Sheffield, UK.
authors.forename: A
authors.initials: A
authors.lastname: Allison
authors.affiliation: School of Health and Related Research, University of Sheffield UK, Sheffield, UK.
authors.forename: S J
authors.initials: SJ
authors.lastname: Walters
authors.affiliation: Sheffield Medical School, University of Sheffield UK, Sheffield, UK.
authors.forename: M
authors.initials: M
authors.lastname: Digby
authors.affiliation: Radiology Department, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK.
authors.forename: P
authors.initials: P
authors.lastname: Broadley
authors.affiliation: Radiology Department, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK.
authors.forename: I
authors.initials: I
authors.lastname: Lang
authors.affiliation: Radiology Department, Sheffield Children's NHS Foundation Trust, Western Bank, Sheffield, S10 2TH, UK. amaka.offiah@nhs.net.|Academic Unit of Child Health, University of Sheffield UK, Sheffield, UK. amaka.offiah@nhs.net.
authors.forename: A C
authors.initials: AC
authors.lastname: Offiah
mesh_terms: D000465:Algorithms; D015519:Bone Density; D006801:Humans; D015588:Observer Variation; D015203:Reproducibility of Results; D016103:Spinal Fractures / Q000175:diagnosis*; D013131:Spine
keywords: Children; Diagnostic scoring system; Observer agreement; Osteoporosis; Radiography; Spine; Vertebral fracture; Vertebral morphometry